LIBRARY OF CONGRESS. 

-uC^A 



UNITED STATES OF AMERICA. 



ACCIDENTS 

AND 

EMERGENCIES 

DULLES. 




Showing the Course of the Principal Blood Vessels. 
See page 69. 



ACCIDENTS 



AND 



EMERGENCIES 



A MANUAL 



OF THE TREATMENT OF SURGICAL AND OTHER INJURIES 
IN THE ABSENCE OF A PHYSICIAN. 



CHARLES W. V T)ULLES, M.D., 

I* 

FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA AND OF TH1 

ACADEMY OF SURGERY; SURGEON TO THE OUT-DOOR DEPARTMENT 

OF THE HOSPITAL OF THE^ UNIVERSITY OF PENNSYLVANIA AND 

OF THE PRESBYTERIAN HOSPITAL, IN PHILADELPHIA, ETC. 






THIRD EDITION, REVISED AND ENLARGED. 

m.ii\ Ntfo Illustration*. 






AP. 27 i. -r 

PHILADELPHIA : 

P. BLAKISTON, SON & CO., 

No. 1012 Walnut Street. 

1883, 



t 






^ 



Entered according to Act of Congress, in the year 1888, by 

P. BLAKISTON, SON & CO., 

In the Office of the Librarian of Congress, at Washington, D. C. 



PRESS OF WM F. FELL & CO., 

1220-24 SANSOM ST., 

PHILADELPHIA. 



PREFACE TO THIRD EDITION. 



The exhaustion of two editions of this little book 
encourages the author to believe that it has proved 
useful in the past, and he presents this third edition 
in the hope that it may also prove useful. 

Whoever has seen how invaluable, in the presence 
of accident, is the man or woman with a cool 
head, a steady hand, and some knowledge of what is 
best to be done, will not fail to appreciate the 
desirability of possessing these qualifications. To 
have them in an emergency, one must acquire them 
before it arises, and it is with the hope of aiding any 
who wish to prepare themselves for such demands 
upon their own resources that the following sugges- 
tions have been put together. They are not meant 
to be elaborate, but simple and practicable. They 
cannot take the place of calling a physician or sur- 
geon, but may fill up with helpful action what might 
otherwise be a period of inaction and despair, before 
skilled assistance arrives. With this view I trust 
they may prove of some value to the public, to whom 

they are offered. 

v 



If the author may be permitted to suggest the way 
in which the instrument he has constructed ought to 
be used, it is as follows : Let it be read through, at 
least once, as carefully and as studiously as possible, 
so that the reader may make the acquaintance of its 
suggestions ; and then let it be kept in some handy 
place, where it can be referred to immediately when 
an emergency arises. In order to make it available 
for sudden necessity, pains have been taken to make 
the index as complete as possible, and the typography 
has been so arranged as that leading words may 
catch the eye on every page. 

Philadelphia, March, 1888. 



VI 



TABLE OF CONTENTS. 



PAGE 

Preface v 

Preliminary Remarks 9-1 1 

Obstructions to Respiration 12-19 

Drowning 12 

Strangulation 16 

Suffocation 16 

Choking 17 

Foreign Bodies in the Eye, Nose and Ear . . . 20-23 

Fits or Seizures 24-34 

Unconsciousness ■ 24 

Fainting 29 

Hysterics 30 

Epileptic Fits 30 

Convulsions in Children 32 

Apoplexy 32 

Intoxication 33 

Catalepsy 34 

Injuries to the Brain 35 

Effects of Heat 36 

Burns or Scalds 36 

Sunburn 38 

Sunstroke, or Heatstroke 38 

Heat Exhaustion 39 

Lightning Stroke 40 

Effects of Cold 41, 42 

Sprains 43, 44 

Dislocations 45~47 

Fractures 48-53 

vii 



Vlll CONTENTS. 

PAGE 

Wounds 54-62 

Contusions 54 

Contused Wounds 55 

Incised Wounds 55 

Lacerated Wounds 56 

Punctured Wounds 57 

Splinters 58 

Poisoned Wounds 59 

Gunshot Wounds 61 

Railroad and Machinery Accidents 63, 68 

Hemorrhage — Bleeding 69-79 

Special Hemorrhages 80,81 

Transportation of Injured Persons 82-84 

Poisons 85-95 

Domestic Emergencies 96-103 

Cholera Morbus 96 

Vomiting or Nausea 97 

Diarrhoea 98 

Croup 99 

Whooping Cough 100 

Asthmatic Attacks • 100 

Nervous Attacks 101 

Toothache 101 

Earache 102 

Poisoning with Poison Vine 102 

Signs of Death 104-106 

Supplies for Emergencies . ■ .. ? 107 

Surgical Case 107 

Use of Contents of Surgical Case 108 

Bandaging 109 

How to Make Poultices 112 

Medicine Chest 114 

Doses and Uses of the Medicines 115 



ACCIDENTS 



AND 



EMERGENCIES 



PRELIMINARY REMARKS. 

There is nothing so important in the presence of 
an accident or emergency as that some one with 
coolness and information enough should assume 
command and begin to set things right. Such an 
one will rarely fail to be recognized by those less 
efficient, and will usually find little difficulty in so 
directing them that they shall render some valuable 
assistance, or, at least, do no harm to the sufferer. 
Bystanders should first be urged not to crowd, but 
to leave room for breathing and action. Any scream- 
ing or wailing should be stopped, if possible. Then 
enough, and no more persons than are needed, 
should be called on to assist in removing the one in 
danger, or if he be crushed, in removing whatever 
presses upon him. Next his body should be placed 
in a comfortable position, lying down, with the 
head a very little raised ; after which an investi- 
b 9 



10 ACCIDENTS AND EMERGENCIES. 

gation may be made to find out, as nearly as pos- 
sible, what is wrong, and a line of subsequent action 
decided upon. 

Some one should now be dispatched for a doctor, 
with a written message, if possible, and certainly 
with one that shall give the doctor a good idea of 
what he may expect to find when he arrives, so that 
he may come provided with necessary instruments or 
remedies. 

While awaiting him, whatever may be advisable is 
to be done by those at hand. Clothing may have 
to be loosened or removed, efforts at resuscitation 
made, a stretcher provided, or other means of trans- 
portation. Hot or cold applications may be needed, 
and should be got ready. Temporary splints, or 
means to control bleeding, may be required. These 
the bystanders ought at once to attend to. One thing, 
however, they ought not to do. That is, to give 
large quantities of whisky or brandy, as is the almost 
invariable custom with people who know nothing, 
but want to do something. If stimulants seem to be 
called for, the non-medical had better stick to hot 
water, or tea, or coffee, or milk; for alcoholic 
stimulants, except in small quantities, are, as a rule, 
not only unnecessary, but actually harmful. They 
often injure the patient, mislead the doctor, and 
interfere with the proper treatment of the case. 

Exceptions to this general statement may be dis- 
covered ; but they are exceptions — this is the rule. 



PRELIMINARY REMARKS. 11 

Another important point to be observed, is not to 
do too much. It will be making a bad use of in- 
structions designed to bridge over the interval be- 
tween the occurrence of an accident and the coming 
of one whose whole time is given to the work of 
healing, if one who knows no more than can be 
gleaned from a little manual should act as if it had 
made a veritable doctor of him. Such presumption 
might lead to great mortification of the amateur and 
to great injury of the sufferer. The true principle is, 
when the urgency is pressing, to do what is known 
to be helpful ; and when one is not sure, to do 
nothing. 



12 ACCIDENTS AND EMERGENCIES. 



Obstructions to Respiration. 

Drowning. It may seem almost absurd to say 
that the first thing to be done when one has been 
exposed to drowning is to remove the person from 
the water. Yet I well remember to have seen, some 
years ago, the revolting spectacle of a woman's 
body, fastened with a rope, floating in a river, and 
gazed at by hundreds of curious people. Upon 
inquiry, a policeman gravely informed me that no 
one dared take it out before the arrival of the 
Coroner. This is a mistake ; any one who thinks 
there is a chance of resuscitation should remove 
from the water a person presumed to have been 
drowned, and at once set about the work. 

If natural breathing has ceased, the first thing to 
be done is to free the body from any clothing which 
binds the neck, chest or waist, and to turn it over 
upon the face for a moment, thrusting a finger 
into the mouth and sweeping it round, to bring 
away anything that may have gotten in or accumu- 
lated there. Then the body should be laid out flat 
on the back, with something a few inches high under 
the shoulders (anything will do : a folded blanket, 
or a shawl, or coat, or stick of wood), so as to cause 



DROWNING. 



13 



the neck to be stretched out and the chin to be car- 
ried far from the chest. The tongue should now be 
drawn well forward out of the mouth and held by an 
assistant, or, if there be no one to do this, a pencil or 
small stick may be thrust across the mouth on top of 
the tongue and back of the last teeth, to keep the 
mouth open and the tongue out of the throat. A 
very good way to get the base of the tongue clear of 
the windpipe is to press the angles of the jaw for- 
ward with both thumbs applied just in front of the 
lobes of the ears. 

An effort to secure artificial 
respiration should now be be- 
gun. The simplest way to do 
this is for some one to place 




Fig. i. 



himself on his knees behind the head, seize both 
arms near the elbows and sweep them round horizon- 
tally, away from the body and over the head till they 
meet above it, when a good, strong pull must be 
made upon them, and kept up for a few seconds. 
This effects an inspiration — fills the lungs with air, 



14 



ACCIDENTS AND EMERGENCIES. 



by drawing the ribs up, and so enlarging the cavity 

of the chest. The second manoeuvre consists in 

returning the arms to their former position alongside 

the chest, and making strong pressure against the 

lower ribs, so as to drive the air out of the chest and 

effect an act of expiration. This need occupy but a 

second of time. 

If this plan is regularly 

carried out it will make 

about sixteen complete 

acts of respiration in a 




Fig. 2. 



minute. It should be kept up for a long time, and 
not abandoned until a competent person has ascer- 
tained that the heart has ceased to beat. The cessa- 
tion of the pulse at the wrists amounts to nothing as 
a sign of death ; and often life is present when only 
a most acute and practiced ear can detect the sound 
of the heart. In a moderately thin person, deep 
pressure with the finger ends just below the lower 
end of the breast bone may sometimes reveal pulsa- 
tion in the aorta, the main artery of the body, when 
it cannot be found anywhere else. 

It is important that the wet clothing shall be re- 
moved as soon as possible from a drowned person. 



DROWNING. 15 

This can always be done without interrupting the 
artificial respiration. If exposure of the person must 
be avoided, something may be laid over the body (a 
coat, a shawl, a blanket, a sail), and the wet clothes 
loosened under it and drawn down over the feet. 
Then the body may be quickly slipped on to some- 
thing dry, and covered with some other fabric, if 
the first has become wet, while this, in its turn, is 
pulled away from underneath. 

Warmth is to be secured by any means which in- 
genuity may suggest — hot bottles, or plates, or bricks, 
or stones, or even boards that have lain in the summer 
sun. At the seashore there is plenty of hot sand, 
and often plenty of baking bathing costumes. The 
body and limbs may be gently, but constantly, rubbed 
toward the heart, to help the blood in its labored 
circulation. None of these things need interfere 
with the efforts to secure respiration, which must be 
uninterrupted. 

Some stimulant is to be given as soon as it can be 
swallowed. Teaspoonful doses of whisky* or brandy, 
in a tablespoonful of hot water, may be given every 
few minutes, till the danger point is passed. 

As natural respiration begins to be attempted, it 
should be aided as much as possible by timing the 
artificial to it. It may be stimulated by applying 
smelling salts, or hartshorn, to the nose, by slap- 
ping the skin, or by dashing hot water upon the 
chest. Where it is available, there is no stimulus to 



18 ACCIDENTS AND EMERGENCIES. 

respiration better than that of a good Faradic bat- 
tery, used so as to cause a reflex sobbing, or deep 
breathing, by the pain it causes. Little by little 
natural breathing will take the place of the arti- 
ficial, but must not be left unwatched for some time. 

Nothing but danger from cold, or pressing neces- 
sity, should prompt the removal from one place to 
another of a person who is being resuscitated, before 
this has been thoroughly accomplished. If removal 
cannot be avoided, it must be effected with great 
care. After resuscitation the person should be put 
in a warm bed, being carried carefully, with the head 
low, and a watch should be kept to see that the 
breathing does not suddenly stop. 

Where natural breathing has not ceased, all the 
steps just described should be carried out, with the 
exception of artificial respiration. But this should 
be had recourse to upon the first evidence that natural 
respiration is failing. 

Strangulation, by hanging, or by anything 
which compresses the windpipe from the outside, is 
to be treated by re-establishing the respiration in 
the same way as for drowning. The obstruction is, 
of course, to be removed and natural respiration 
stimulated or artificial respiration employed. 

Suffocation with Noxious Gases or Vapors 
calls for instant removal to the fresh air and the 
establishment of natural respiration, or of artificial 
until the natural is re-established, as described in 



OBSTRUCTIONS TO RESPIRATION. 17 

speaking of Drowning (Page 1 2). Gases like carbonic 
acid, illuminating gas, the fumes of charcoal, and the 
collections in mines, wells or privies, are very dan- 
gerous to life. The removal of a person from a well 
full of a poisonous gas is a very difficult and delicate 
matter. Some attempt may be made to dislodge or 
dissipate the gas. Buckets of water may be dashed 
down, or an open umbrella lowered by the handle 
and rapidly drawn up a number of times. But 
these efforts must not consume any more time than 
is required to prepare a man who can be lowered, 
securely fastened to the rope, so that he can attach 
another rope to the person overcome in the well. 
The rescuer must be brave, cool and strong, and 
those who lower him no less so. He may be some- 
what protected by wearing a sack over his head, or 
having a thick vail over his face. But everything 
will depend upon the rapidity with which he and his 
comrades can do their work. 

Choking caused by something sticking in the 
throat, gullet or windpipe demands its removal as 
soon as possible. It is not always easy to tell which 
of these latter passages is clogged, but usually there 
is active irritation, with coughing, when a foreign 
body lodges in the windpipe, while swallowing can 
be done quite readily. On the other hand, when the 
gullet is stopped it is usually impossible to swallow, 
and there is little or no tendency to cough, no matter 
how much the breathing may be interfered with. 



18 ACCIDENTS AND EMERGENCIES. 

About the throat, it is not so hard to tell, for one can 
usually see or feel with the ringer the offending body. 

If a foreign body be within reach of two fingers, 
it may be pretty easily removed. If not, a pair of 
blunt-pointed scissors may be used like forceps. Or 
a hair pin may be straightened out and one end 
bent round so as to make a loop, and this used to try 
to dislodge the foreign body ; or the handle of one 
blade of a pair of scissors may be used in the same 
way. It has been stated that for foreign bodies in 
the throat, such as pieces of meat, etc., a simple 
mode of relief is to blow forcibly into the ear. This 
sometimes excites powerful reflex action, during 
which the foreign body is expelled. Such a plan is 
so easy of execution that it is certainly worth trying. 

Children not infrequently get buttons, or coins, 
or marbles in their throats, and come near choking 
to death. These may often be pulled out, or expelled 
by vomiting, if this can be provoked. Holding the 
body up by the legs, with the head hanging down, 
has sometimes aided other efforts to get rid of such 
things, The responsibility of attempts to poke them 
down may well be left for the surgeon. 

If pins, or needles, or fish bones, get stuck in the 
mouth or throat, it is sometimes an extremely deli- 
cate matter to remove them. Sometimes, on the 
other hand, they may be grasped with the fingers or 
a pair of blunt scissors — used like forceps — and pulled 
out. If this cannot be done, the patient should be 



OBSTRUCTIONS TO RESPIRATION. 19 

made to lie down, and kept as quiet as possible in 
body and mind, till some one comes who can give 
relief.* 

If foreign bodies get into the windpipe they will 
soon be coughed out, or require surgical skill for 
their removal. A moderate blow on the back with 
the open hand, or a quick strong squeeze of the 
chest, sometimes aids the coughing act ; and invert- 
ing the body may assist in dislodging the foreign 
body if it be not too tightly wedged in. 

In any case where the breathing is not seriously 
interfered with, it will be most prudent for non- 
medical persons to keep " hands off." For there 
may no longer be anything in the throat, though it 
appears there is ; and it can do no good to make 
groping efforts to bring away foreign substances 
friat have already gone down into the stomach, only 
leaving behind an irritation which deceives the 
patient and his friends. 

When strange things, like coins, or marbles, or 
slate pencils, or nails, are swallowed by children (or 
adults), it is a mistake to give a purgative. The 
proper plan is to let the bowels alone and to give 
plenty of good solid food, especially vegetables, so 
that the foreign body may be surrounded with the 
waste and carried out of the body without injuring 
the walls of the intestines. 

* The practice, by adults, of putting pins in the mouth, is neither clean 
nor safe, and is to be discountenanced. 



20 ACCIDENTS AND EMERGENCIES. 



Foreign Bodies in the Eye, Nose 
and Ear. 



Foreign Bodies in the Eye. Small substances 
like cinders, dust or small chips of stone or metal, 
can usually be removed from the eye by very simple 
means. Sometimes there is at once a free flow of 
tears which washes them out. At others, the com- 
mon way of catching the upper lid by the lashes and 
pulling it away from the eyeball and down over the 
lower lid, then letting it go so that as it recedes its 
under surface is swept by the lashes of the lower lidf* 
will clear it out. 

If this does not prove successful, a loop made of a 
horse hair, or a long human hair, can be passed 
under the lid and swept, from the outer side, toward 
the nose and drawn down. This may serve the 
purpose. 

If it does not, the upper lid must be everted, or 
turned inside out. This is easy to do. One way is 
to seize the lashes between the thumb and first finger, 
and to draw the edge of the lid away from the eye- 
ball. At the same moment the end of the second 
finger is pressed against the skin of the lid above its 



FOREIGN BODIES IN EYE, NOSE AND EAR. 21 

edge. The patient is now told to look down, and, 
as he does so, the lashes and edge of the lid are 
pulled upward toward the eyebrow, while the upper 
part is tucked under it with the end of the second 
finger. Another -plan is to draw the lid down, take 
a slender pencil, or knitting or crochet needle, and 
place it against the eyelid, parallel to and one-third 
of an inch above the edge, and then to pull the edge 
up and turn it over this by means of the lashes. 

The lower part of the eye is easy to examine, be- 
cause the lower lid is so easy to turn down. 

In this way a large part of the eyeball and eyelid 
can be examined and any foreign substance re- 
moved. A magnifying glass is sometimes needed to 
see fragments that have given a great deal of 
trouble. 

One must be on his guard against the sensation 
which is sometimes left after a foreign body has 
been removed from the eye. It often feels to the 
sufferer as though this were still in his eye when it is 
not. But a most careful search should be made 
before this is taken to be a self-deception ; and even 
then it would be better to consult a more skilled 
person. 

After removing a foreign body from the eye, the 
irritation may be sufficient to demand cool, wet ap- 
plications, or even anodynes. Nothing is better 
than a thin mucilage of pure, clean gum-arabic 
poured freely in the eye. Or, a little laudanum may 



22 ACCIDENTS AND EMERGENCIES. 

be poured into a heated cup, and when evaporated 
to a kind of jelly it can be thinned out with clear 
water and this poured into the eye. A bandage, 
loosely applied so as to shut out light and keep the 
eyeball rather quiet, often does much good. 

When lime gets in the eye it burns very severely. 
At once the eye should be deluged with water, and 
a little vinegar or lemon juice and water (a teaspoon- 
ful of vinegar or lemon juice to a teacupful of water) 
poured over the eyeball. 

Foreign Bodies in the Nose. Children 
sometimes place, or have placed, in their noses small 
bodies, such as marbles, buttons, peas, beans or 
small grains. To get rid of them, the nose should 
be blown hard; or, sneezing may be excited by 
tickling the nose or giving snuff ; or, the child may 
be told to take a full breath and then be given a 
smart blow on the back. Some one of these plans 
may dislodge the foreign body. If it does not, rea- 
sonable efforts may be made to fish it out with a 
bent hair-pin, a bodkin, the handle of a mustard or 
salt spoon, or something of that sort. But these 
efforts must not be rough or prolonged ; for they 
may do much damage; and if a surgeon must be 
called, the sooner it is done the better. The longer 
it is delayed, the harder will be his work and the 
worse for the child. In case peas or beans are 
lodged in the nose, the danger is increased by the 



FOREIGN BODIES IN EYE, NOSE^ AND EAR. 23 

fact that if they absorb any moisture, they swell up 
and are very difficult to get away. 

Foreign Bodies in the Ear. The removal of 
foreign bodies from the ear is more delicate than 
when they are in the nose, because there is no way of 
getting at them from behind, and there is no natural 
force to be called to one's assistance. Consequently 
it usually requires special instruments. Yet, if no 
medical man be attainable at all, and if it be remem- 
bered that the outer passage of the ear is about an inch 
deep and very delicate, something may be done. 

If the body be a metal or mineral one, the ear 
may be syringed out thoroughly. The person's head 
must be held with the face down, as in this position 
gravity lends some assistance. Very gentle efforts 
may even be made to remove any foreign body with 
a crochet needle, or a hair-pin, or an ear spoon, if it 
can be had. But with all these it must be remem- 
bered that great damage may be done by the least 
roughness. 

If live insects get into the ear, oil or glycerine or 
salt and water should be poured in. Or, a plug of 
cotton soaked in a strong solution of salt and vine- 
gar may be placed in the ear and the head turned 
over on that side. 

An ingenious method, which has sometimes been 
successful, is to turn the ear at once to a bright light, 
so as to tempt the insect to back out, on account of 
the attraction which light has for all these creatures. 



24 ACCIDENTS AND EMERGENCIES. 



Fits or Seizures. 



Unconsciousness, or Insensibility, occurs in 
many different conditions, and it is of great import- 
ance that something should be known about them by 
those who meet many strangers, or have the care of 
large numbers of employees. To this class belong 
railway officials and railway servants, manufacturers, 
superintendents of mines and public works, survey- 
ors, constructors, keepers of hotels, and schoolmas- 
ters, and policemen. The former might often do 
priceless service to those who come under their care, 
and the last might escape much blame and avoid some 
unfortunate mistakes, if they could always distinguish 
disease from disorder and drunkenness. 

This, it must be acknowledged, is often hard to 
do. But so much the more reason is there for at- 
tempting to learn enough to prevent such shameful 
mistakes as are sometimes made. So, before speak- 
ing of the treatment of conditions in which uncon- 
sciousness may be present, a little space may be 
devoted to considering, in a general way, how one 
may decide what unconsciousness is due to. 

For our present purpose the causes of uncon- 
sciousness may be classified as : disorders of the 



FITS OR SEIZURES. 25 

circulation, disorders of the brain, poisoning, and 
intoxication. 

Unconsciousness due to Disorder of the Cir- 
culation, or temporary failure of the heart, is^ famil- 
iarly illustrated in fainting. This may be brought 
about by a simple nervous influence, or by a sudden 
shock, or by loss of blood. In any case, the condi- 
tion is easily recognized by itself or from its cause. 
It is marked by paleness of the face, and usually by 
coldness of the extremities. 

Unconsciousness due to Disorder of the 
Brain may depend upon disease or injury. Disease 
of the brain is recognizable, from its gradual ap- 
proach, which can be learned from the sufferers 
friends, and is not much more likely to prove per- 
plexing than is fainting. On the other hand, inju- 
ries of the brain are usually accompanied by external 
signs, such as dirt, swelling, bruises or cuts, which 
show that violence has been inflicted ; or, they occur 
under circumstances which make a suspicion of vio- 
lence reasonable. In apoplexies some of the external 
evidences might prove misleading, but besides these 
there is often found an unequal dilatation of the 
pupils, and paralysis on one side of the face and body. 
In the unconsciousness of epileptic convulsions there 
is usually little trouble in deciding what is present, 
from the frothing, and biting of the tongue or lips, 
and the peculiar cry before unconsciousness sets in, 
with which every one is familiar, 
c 



26 ACCIDENTS AND EMERGENCIES. 

Unconsciousness due to Poison may be 

caused by a poison generated within the body: 
an example of which sometimes occurs in serious 
kidney disease. In such cases there are usually 
convulsions as well as unconsciousness, and often a 
dropsical appearance about the eyes and legs, very 
profound stupor, and a smell like that of urine about 
the person affected. 

The cause of poisoning by gases is generally easy 
to detect. The only insensibility due to drugs which 
is actually likely to be confused with intoxication 
is that caused by opium or chloral. But in this the 
pupils are strongly and rigidly contracted — the very 
opposite of what is seen in drunkenness. 

Unconsciousness due to Intoxication is 
marked, it is true, by many signs of other insensibili- 
ties, but it has these peculiarities : the face is usually 
flushed, the body relaxed everywhere, the person ca- 
pable of being roused by loud cries, the pupils dilated 
evenly, and a distinct odor of liquor to be dis- 
covered. 

When a doubtful cases arises the first thing to be 
done is to see if there is an odor of liquor to be dis- 
covered. If there is not, one may be sure he is not 
dealing with a case of intoxication. But if, on the 
other hand, the odor is present, one must not con- 
clude at once that the case is one of simple drunken- 
ness. For it often happens that liquor is given after 
an accident, and an accident may have happened to 



FITS OR SEIZURES. 27 

a man who had been drinking. To avoid mis- 
take : — 

i. The head must be examined. If there is a cut 
or a bruise, the only safe thing to conclude is that 
there is a brain injury, received before or after the 
liquor was taken. 

2. The pupils of the eyes must be examined. If they 
are permanently contracted and do not dilate when 
the eyes are shaded, it is probably a case of brain 
disease or opium poisoning. If one pupil is con- 
tracted and the other dilated, it is a case of injury 
or disease of the brain. 

3. The face must be examined. If it is drawn and 
wrinkled on one side, and smooth on the other, the 
case is one of apoplexy, or stoppage of a blood vessel 
in the brain, or pressure upon some part of the 
brain. 

4. The mouth must be examined. If it be frothy 
and if the tongue or the lip be bitten, it is probably 
a case of epilepsy or some other convulsive disorder 
— not simply intoxication . Of course, it will be borne 
in mind that the tongue may be bitten accidentally 
by being caught between the teeth in a fall. 

5. The arms and legs must be examined. If one is 
stiff and one limber, or if one moves when pinched 
and the other does not, it is a one-sided paralysis, or 
hysterics. If it be the latter, the person affected will 
usually resist any attempt that may be made to open 
the eyelids; and when the eyelids are forcibly 



28 ACCIDENTS AND EMERGENCIES. 

opened the eyeballs will usually be found persist- 
ently rolled up, which may be regarded as an almost 
infallible evidence of hysterics. At the same time 
close watching will generally lead to the discovery 
of some sign that the affected person is listening to 
what is being said about him or her. 

6. The temperature of the skin must be investigated. 
If the skin be burning hot and dry, sunstroke or heat- 
stroke may be suspected, if the time of year or the 
occupation of the patient warrant such conclusion. 

After all these tests have been applied, there will 
still be a few cases where it will be hard to say — in 
the presence of an odor of alcoholic liquor — whether 
there is, or is not, some more serious trouble than 
mere drunkenness present. In these few cases the 
only safe course is to take it for granted that there is 
some other trouble present — even if there be intoxica- 
tion, too — though it be at the risk of being sometimes 
deceived and imposed upon. When there is any 
such doubt the person should be transported and 
treated with great care, an attempt being made to 
discover what is the disease or injury which, alone or 
combined with intoxication, has produced the con- 
dition in which he has been found. Such a person 
should never be made to walk to a station house or be 
confined alone, or be permitted to escape the vigilance 
of those who take charge of him, till they can rest 
the responsibility of his fate on others better in- 
structed or in authority over them. 



FITS OR SEIZURES. 29 

The treatment suitable for all cases in which there 
is doubt as to the cause of unconsciousness is to secure 
quiet and rest, the body being laid upon the back, 
with the head a little raised. If there be great 
paleness and a cold surface, with slow, sighing 
breathing — the signs of prostration : smelling salts 
or hartshorn may be held un.der the nose, hot tea or 
coffee given, and heat applied to the body. If there 
be great heat of the surface, cold may be applied to 
the body and head, and cold drinks given. 

With these general remarks on the way to decide 
between simple intoxication and other causes of loss 
of consciousness, let us now consider separately the 
way in which doubtful cases should be managed, and 
several common forms of fits or seizures. 

Fainting is too familiar to need much detail of 
symptoms. It is due to a temporary weakening or 
pause in the heart's action, causing a diminution 
or suspension of the circulation of blood in the 
brain, and a consequent loss of consciousness. This 
is accompanied with a loss of muscular power, so 
that the individual, if standing, falls. The pallor 
of fainting is very well known, and is simply a signal 
of the like bloodlessness which obtains in the brain 
itself. Usually no treatment is demanded in faint- 
ing, for a wise provision of Nature puts the person 
who faints in the best position for recovery, that is, 
lying down. But if in any way this is prevented 
from happening of itself, it should be brought about 



30 ACCIDENTS AND EMERGENCIES. 

by a bystander. A fainting person must be laid out 
flat at once. The head must be put as low as, or 
lower than, the body, so that the heart may not 
have to work against the force of gravitation in send- 
ing blood to the brain. Sprinkling water upon the 
face, and holding smelling salts to the nose tend to 
excite the nerves of sensation, and rouse the brain 
and heart to renewed activity. So they are useful. 
Nothing else is usually necessary ; though if a person 
is very slow in coming to, it may be well to apply 
heat to the pit of the stomach. But of all, the first, 
the indispensable thing, is to lay the fainting person 
down flat. Nothing should be allowed to interfere 
with this. 

Hysterics — not hysteria, for that is usually a 
tedious and inscrutable nervous disease — but fits of 
hysterics, marked by prolonged and uncontrollable 
laughing or crying, are best treated by the exercise of 
calmness and patience on the part of the bystanders, 
sometimes by taking no notice of the attack,, or by 
leaving the unfortunate sufferer in a room by herself 
or himself — for men are at times subject to this 
curious disorder. Heroic measures, like dashing 
water into the face, are not to be generally recom- 
mended. Good is sometimes done by giving vale- 
rian or Hoffman's anodyne, if it can be obtained. 

In Epileptic Fits the sufferer usually has a warn- 
ing sensation, and often starts up to leave the place 
he is in. There is in the attack a pallor or lividity 



FITS OR SEIZURES. 31 

of the face, a peculiar cry, loss of consciousness, a 
moment of rigidity, and then the face becomes con- 
gested and violent convulsions come on. In these 
there is usually some foaming at the mouth, the eyes 
roll or are turned up, and often the tongue or lips 
are bitten. 

Epileptic fits are to be treated very much like 
fainting fits, because in them also the brain is tempo- 
rarily bloodless. At the same time any movements 
calculated to injure the person must be controlled. 
There is no use in struggling against such as will do 
no injury ; they had better be simply regulated, and 
no attempt made to entirely prevent them ; but a 
folded towel or a piece of soft wood may be — if it can 
be — thrust between the teeth, to prevent the usual 
biting of the tongue. When the height of the con- 
vulsion is passed, rest, quiet, and perhaps a moderate 
stimulation may be secured. Here again the flat 
position of the body must be obtained. 

I remember, one summer, at the seashore, to have 
seen some ill-advised, though kind-hearted, persons 
walking a boy up and down the beach during an 
epileptic attack, because, from his pallid face, they 
thought he was suffering from the cold ; and they 
were much astonished at the rapidity with which he 
regained consciousness when laid out flat on the sand. 

It would be a good plan if every one who is sub- 
ject to epileptic attacks had his, or her, name and 
address placed just inside the coat, or in some place 



32 ACCIDENTS AND EMERGENCIES. 

where it could be seen at once when the clothing is 
loosened to give relief, as is almost invariably done 
when such attacks occur. Epileptics should not, 
except when it is absolutely unavoidable, go about 
alone, or go into crowded places. They have no 
right, on their own account and for the sake of others, 
to incur the risks involved in such conduct, except 
under the stress of necessity. 

Convulsions of Children and Infants are 
generally (in the absence of brain or kidney disease) 
due to some irritation of the digestive apparatus or 
to teething. They are usually preceded by some 
other evidence of irritation, such as restlessness 
and fretfulness. When they come on, there is a 
loss of consciousness, and spasms. These may affect 
the whole body at once, or only a half, or only 
one limb at a time. The eyeballs sometimes roll 
about, or they squint, or they are turned far up so 
that only the lower part of them can be seen. 

When convulsions occur, the child should have cold 
applied to the head and heat to the body. It often 
seems to do good to place it into a tub of hot water 
to which some mustard has been added. 

A large injection of hot soap suds should also be 
given, to clear the bowels out, and, if possible, an 
emetic, in the hope of removing some cause of trouble 
from the stomach. 

Apoplexy consists in the rupture of a blood vessel 
in the brain, and is marked by a slow pulse, more or 



FITS OR SEIZURES. 33 

less sudden loss of consciousness, stupor, heavy snor- 
ing breathing, and usually a deeply flushed face. The 
pupils are generally dilated. Paralysis may be ob- 
served at once, or it may appear after some time. 
Usually it is limited to one side, and may be detected 
by observing that one side of the face is drawn up, 
while the other looks flabby, and the corner of the 
mouth on that side hangs down a little. The drawn 
side is not the paralyzed one, as is sometimes sup- 
posed. 

For this condition, rest and cold to the head con- 
stitute the best treatment until medical advice, which 
is indispensable, can be obtained. If this cannot be 
had for some time, the bowels should be emptied, if 
possible, with an injection of hot water and soap, 
and a purgative given by the mouth as soon as it can 
be swallowed. 

Intoxication sometimes closely resembles apo- 
plexy, and should be treated in the same way until 
its identity can be safely established. For this the 
odor of the breath is a useful guide, though it 
may be due to a stimulant, given by a bystander after 
an accident, or taken just before one. In addition, 
it may be remembered that, in a case of deep drunk- 
enness there is no paralysis, though there is help- 
lessness equally on both sides ; that the person can 
be aroused from the stupor, and that generally if the 
eyeball be touched he will attempt to close the eye- 
lids. In such a case an emetic should be given, and, 



34 ACCIDENTS AND EMERGENCIES. 

if any hartshorn or aromatic spirits of ammonia is at 
hand, a teaspoonful of this in a teacupful of water. 
A large draught of vinegar will often go a great way 
toward sobering an intoxicated person. If there is 
much evidence of prostration, with cold, clammy 
skin, heat will have to be applied to the body, to 
prevent collapse. 

Emetics are sometimes of value in cases of profound 
intoxication ; but it must be borne in mind that, if a 
mistake be made — as has been — and the trouble be 
an apoplexy, no more dangerous thing could be done 
than to give an emetic. 

Catalepsy is a very rare state, somewhat resem- 
bling death, marked by more or less pallor of the 
skin, rigidity of the muscles, and apparent uncon- 
sciousness. In itself it is by no means dangerous, 
and it affords time enough to summon a doctor ; 
which is the only sensible thing to do under these 
circumstances. 



INJURIES TO THE BRAIN. 35 



Injuries to the Brain. 

Concussion of the Brain, or stunning, may be 
caused by blows or falls on the head, or even by falls 
upon the feet. In such cases there is sickness, some- 
times fainting, with paleness and depression. There 
is also usually confusion of ideas, and the sufferer 
cannot talk continuously and coherently. There 
may even be unconsciousness. 

The proper treatment for this condition is to lay 
the sufferer out flat on the back, loosen any clothing 
that binds his neck or waist, and secure quiet and 
plenty of fresh air. If the skin becomes cold and 
clammy, heat should be applied to the body and 
limbs. No whisky or brandy should be given, 
except by a doctor's order. 

Compression of the Brain. This is caused by 
the pressure of broken bone upon the brain after a 
fracture of the skull, or by the pressure of blood 
poured out in a hemorrhage inside of the skull. The 
symptoms are loss of consciousness, sometimes par- 
alysis, sometimes twitching of the muscles, or even 
convulsions, and usually heavy snoring breathing, 
with wide dilatation of one or both pupils. The 
treatment is the same as for apoplexy. (See p. 32.) 



36 ACCIDENTS AND EMERGENCIES. 



Effects of Heat. 



Burns or Scalds are usually dangerous in pro- 
portion to their extent and depth. Those which 
involve as much as half the surface of the skin are 
almost necessarily fatal. 

The treatment of burns may be divided under two 
heads. The first is for the moment of the accident. 
When clothes are on fire the wearer must not run 
about, but lie down and be covered with a rug, or 
blanket, or carpet, or shawl, or coat — anything 
which will exclude the air and smother the flame. 
If, in fright, the sufferer lose presence of mind, some 
bystander must take the responsibility of throwing 
her (for these accidents usually happen to women, on 
account of the character of their clothing) down and 
enveloping her with some thick cover. 

After an extensive burn or scald, so much of the 
clothing as has to be removed must be clipped away, 
so as not to burst blisters that have formed. These 
may be punctured at one edge and their contents 
allowed to run out, and the elevated cuticle, or outer 
skin, to fall down upon the deeper layer. Then a 
dressing of pure sweet oil, or castor oil, is to be 
applied on strips of soft old linen, and disturbed as 



EFFECTS OF HEAT. 37 

little as possible afterward. It is customary in hos- 
pitals to clip away the clothing and envelop the 
patient in lint soaked in " Carron oil " (which is a 
mixture of equal parts of linseed oil and lime water), 
and to administer stimulants and anodynes. In case 
of a person severely and extensively burned, the 
entire body may be immersed in a bath, which shall 
be kept, as long as necessary, at a temperature of ioo°. 
When the shock of a burn is great some stimulant 
should be given, and laudanum, in twenty-drop doses 
to an adult, and half as much to a child, to allay the 
suffering. Of course, medical advice will be taken 
in such grave circumstances. 

Slight Burns or Scalds are best treated by 
applying a cloth soaked in a strong solution of baking 
soda — the bicarbonate, in the proportion of a heap- 
ing tablespoonful in a teacupful of water, or it may 
be powdered on without using any water. This 
usually allays the pain more effectually than anything 
else that is known. Carron oil is a good application 
for such burns. So is the white of egg, and in an 
emergency damp earth might be used, or white lead 
paint. Anything may be used which will prevent 
friction and exclude the air ; but nothing should be 
used which will stick in cakes and prevent after- 
examination, or make this very painful. For this 
reason flour and cotton batting, though often recom- 
mended, had better not be used. For small burns, 
simple cool water is better in every way than these. 



38 ACCIDENTS AND EMERGENCIES. 

Indeed, for any but the most extensive burns it is one 
of the best remedies. An arm or a leg can be 
immersed in it and left there a long while with great 
advantage. 

Burns with acids must be deluged with water 
and then treated like other burns. 

Burns with caustic alkalies, such as soap-lye, 
should be treated with an application of vinegar, 
followed by applications of oil. 

Burns with hot pitch. After such burns the 
pitch often sticks. In such a case it ought not to be 
removed, but let alone. 

Sunburn, and the burns caused by external appli- 
cations, like mustard, may be treated very success- 
fully with the baking soda. This may also be mixed 
with vaseline, or cosmoline, or lard from which the 
salt has been boiled out, in equal parts, and used as 
an ointment. 

Sunstroke, or more properly Heatstroke, is not 
even usually due to the direct rays of the sun, but 
rather to a prolonged elevation of the bodily tem- 
perature, oftenest while working, and especially in 
confined places. When it takes place in the open 
air it is apt to be on oppressive, heavy, or murky 
days. It is generally preceded for some time by 
pain in the head and a sense of oppression. The 
attack, however, culminates in a loss of conscious- 
ness, with heavy, labored breathing, and an intense, 
burning, dry heat of the skin, while the bladder and 



EFFECTS OF HEAT. 39 

bowels are often involuntarily evacuated. The 
absence of perspiration in the presence of so great 
heat is one of the most characteristic symptoms of 
heatstroke. 

When it occurs the thing to be done is to lower 
the temperature. As much of the clothing as pos- 
sible must be removed, and the patient should be 
transported to a cool and airy place, if possible. 
Cold must then be applied to the head and body, 
and ice may be rubbed over the chest and placed in 
the armpits. 

Pouring, or dashing, cold water over the body is 
not to be advised, as it conveys a needless shock to 
the system ; but there is nothing better than to place 
the body in a cold bath, or to wrap it in sheets kept 
wet and cold by renewed applications of cold water 
or ice. After a while consciousness will return. 
Then the cold may be discontinued, and renewed 
only if the surface becomes again very hot — that is, 
hot in contrast to that of a well person, not in con- 
trast to the ice or water that has been used — or in 
case consciousness should be lost again. 

It must always be remembered that sunstroke, or 
heatstroke, is a very dangerous thing, and may be 
followed by grave and permanent impairment of the 
intellect. 

Heat Exhaustion. This is a condition of great 
depression of the system due to the action of heat, 
and, occurring in hot weather, it might be confounded 



40 ACCIDENTS AND EMERGENCIES. 

with sunstroke or heatstroke. But in heat exhaustion, 
instead of a hot, dry skin, there is a cold, moist one. 
This calls for rest, fresh air, a cool apartment ; but 
no application of cold to the surface. Small doses 
of brandy, thoroughly diluted, may be given, and 
the system gradually brought back from its depres- 
sion. 

Lightning Stroke. This is marked by evidences 
of shock, with reduction of the force of the circula- 
tion, weak pulse, and slow, sighing breathing. It 
must be treated with rest and stimulants, and warmth 
applied to the body. 



EFFECTS OF COLD. 41 



Effects of Cold. 



Freezing sometimes takes place in so insidious 
a way that the sufferer is not aware of it until great 
damage has been done. Toes are perhaps oftenest 
frozen or frost-bitten. This results partly from the 
practice of wearing tight and insufficient coverings 
on the feet. When it occurs, it is best treated by 
gradually bringing the temperature up to that which 
is normal — about 98 Fahrenheit — and maintaining 
it there. Warm baths, gentle friction, and afterward 
covering with a thick, hot poultice, is the best thing 
that can be done until medical help can be obtained. 
This is important in such cases, because not infre- 
quently gangrene follows the freezing of the feet, 
making it necessary to amputate parts of them. 
Frozen fingers, ears, or noses are of less frequent 
occurrence, but must be treated on the same prin- 
ciples. 

If the whole body has been exposed to extreme 
cold, there will follow a depression which requires 
the most cautious treatment. To restore its warmth 
is the first demand, and for this a warm bath, made 
gradually warmer until as hot as can be well borne, 
surrounding with heated blankets, or exposure before 

D 



42 ACCIDENTS AND EMERGENCIES. 

an open fire may be used.* At the same time stimu- 
lants may be given internally, such as hot tea or 
coffee, with the addition of small quantities of spirits. 

* This recommendation is contrary to popular belief and contrary to 
what is taught in most text-books, as well as in books on the treatment of 
emergencies. But it has been proved to be correct, by experiments made 
in Russia, where it was found that the best way to resuscitate dogs which 
had been frozen, was to put them at once into a hot bath. Of twenty ani- 
mals treated by the " gradual " method in a cold room, fourteen died; of 
twenty introduced at once into a warm room, eight died ; of twenty placed 
immediately in a hot bath, all recovered. 



SPRAINS. 43 



Sprains. 



Sprains of the finger or wrist usually require 
cold and moist applications. In the latter, the hand 
and forearm should be laid on a straight splint, cov- 
ered with cotton so as to make the surface soft, and 
be lightly secured to it with a soft bandage or broad 
strips of sticking plaster. One of these should go 
round the hand and one or two round the forearm 
above the wrist — not over it. Sprains must be 
treated by rest, and heat or cold, whichever gives 
the most comfort. 

Sprains of the ankle should never be treated 
lightly. In them there is not infrequently a little 
fracture of the inner surface of one of the leg bones 
that form the ankle joint. This complication gives 
rise to so much trouble, and requires such skillful and 
patient treatment, that it has come to be believed 
that it is better to have a broken leg than a sprained 
ankle. The general principle, however, in the case 
of a sprained ankle is, first to put the joint at com- 
plete rest, then to allay inflammation, if it arises, and 
afterward to promote the absorption of inflammatory 
products. For the first, a splint and bandage are 



44 ACCIDENTS AND EMERGENCIES* 

usually necessary ; for the second, friction, kneading 
of the joint, at times careful motion of it, and the use 
of moist heat. But in few cases is it truer that " he 
who doctors himself has a fool for a patient/ ' 



DISLOCATIONS. 45 



Dislocations. 



Dislocations consist of the displacement of the 
articular or joint end of a bone. They cannot occur 
(except when the same joint has been out of place 
before) without the tearing of ligaments whose func- 
tion it is to keep the joint close. They can be 
detected by the occurrence of pain and stiffness of 
the joint. There is also deformity, which can gen- 
erally be made apparent by comparing the injured 
joint with the corresponding sound one of the other 
side. 

Dislocation of the fingers can usually be re- 
duced — or put in place — by strong pulling, aided by 
a little pressure upon the parts of the bones nearest 
the joint. They must be retained in place with a 
splint and bandage, or sticking plaster. Dislocations 
of the thumb are, even for surgeons, sometimes 
almost impossible to put in place. 

Dislocation of the lower jaw may be treated by 
almost any one. This is fortunate, since it is a very 
awkward dislocation, and very trying to the patient. 
It may occur at any time and under the most unex- 
pected circumstances. 

To reduce a dislocation of this sort, the sides of 



46 ACCIDENTS AND EMERGENCIES, 

the jaw must be seized between the thumb and fingers 
of each hand, with the thumbs resting on the teeth 
and the fingers below the jaw, and firm pressure 
be made, first downward and then backward. It 
must be remembered to cover the thumbs with 
several thicknesses of cloth, and as soon as the jaw 
starts into place, to slip them off to the outer side 
of the teeth, inside the cheeks, or the releaser will 
be rewarded by having his thumbs mashed between 
the upper and nether millstones. He must be quick 
as lightning, too, for the muscles do not wait, 
when they have been so unnaturally on the stretch, 
but bring the lower teeth against the upper like a 
hammer. 

There is still another form of dislocation of the 
jaw, in which this is just a little open and cannot be 
opened any wider or closed. The thing to do in 
such a case is to slip a strong spoon handle or table 
knife in between the teeth and pry the jaw wider 
open. This will make the bone slip back into its 
place. 

Dislocations of the shoulder, that is of the 
upper arm bone from its socket, may be reduced by 
laying the patient down, sitting alongside of and 
facing him, and placing the nearest heel (with the 
boot or shoe removed) in the arm pit of the injured 
side, and then drawing down the dislocated arm 
and dragging it over toward the sound side. This 
will usually pry the head of the bone outward and 



DISLOCATIONS. 47 

upward into its place. If it does not succeed readily, 
the amateur surgeon had better let it alone. If it 
does succeed, the bone will go in with a snap. The 
arm should then be bound to the side, with the fore- 
arm carried across the chest and the hand placed on 
the opposite shoulder. 

Dislocations of other joints ought not to be 
tampered with at all. The best that can be done is 
to put the parts in the position easiest to the sufferer, 
surround the joint with cold, wet cloths, to which 
laudanum has been added, and send for a surgeon. 
The risk of doing injury by injudicious efforts to set 
a joint is greater than that of waiting until a surgeon 
can be summoned. 



48 ACCIDENTS AND EMERGENCIES, 



Fractures — Broken Bones. 



Broken bones may be recognized by the occur- 
rence of pain, by deformity, by bending where they 
ought not to bend, and by a sound and feeling of 
grating at the point of fracture. There are two im- 
portant divisions of fractures. Simple fractures, in 
which the break does not communicate by a wound 
with the air, and compound fractures, in which the 
bone cuts through the skin, or there is an opening 
from the exterior to the seat of fracture. The 
latter are far more serious and dangerous than the 
former. 

Broken bones require treatment as various as the 
fractures themselves are. Most of them require 
special appliances, known only to surgeons, and no 
attempt should be made by any one who has not 
surgical training to do more than treat a fracture 
temporarily. However, until the presence of a sur- 
geon can be secured, the following suggestions may 
be adopted, as far as the circumstances will permit. 

Fracture of the upper arm. In this the elbow 
should be drawn down and placed against the side 
of the chest, with a layer of cotton or linen cloth 
between. Then the whole upper arm should be 



FRACTURES — BROKEN BONES. 49 

bound securely to the body and the forearm carried 
in a sling so arranged that the hand shall be raised a 
little higher than the elbow. 

Fracture of the forearm. In this the arm 
should be bent at the elbow, and placed in as nearly 
a natural position as possible, with the thumb point- 
ing up. Then a broad, well -padded splint should be 
placed along the back of the forearm and hand, going 
all the way to the tips of the fingers, and another 
along the front, padded so as to fit to the proper 
shape of the parts. The splints should be bound on 
pretty firmly, and the hand carried in a sling and 
raised a little higher than the elbow. 

Fracture of the finger. A broken finger 
should be straightened out, and bound to a very 
light splint reaching from the wrist to the tip of the 
finger. 

Fracture of the thigh bone. In this fracture 
the thigh must be bent up toward the abdomen and 
the lower leg back toward the thigh, so as to relax all 
the muscles. Then one splint can be applied to the 
outer side of the thigh and one to the inner, and 
bound to it. The sufferer should then have both legs 
tied together, and lie on his side on a firm bed, in 
a z shaped position, with the broken limb upper- 
most, the heel drawn up near to the buttocks, and the 
knee opposite the other knee. 

Fracture of the knee-pan. In this the whole 
leg must be bound to a straight splint placed at the 



50 



ACCIDENTS AND EMERGENCIES. 



back of the limb and going from the hip to the heel. 
A folded towel, or other small pad, should be placed 
in the hollow at the bend of the knee, so that the leg 
may not be held absolutely straight ; for this posi- 
tion soon becomes very painful. 

Fracture of the leg below the knee. In this 
the leg should be drawn down and placed in a natural 
position, using the sound leg for comparison. Then 
a pillow should be placed under it. Under this, 




Fig. 3. 

broad bandages should be passed and tied together 
over the limb, so as to draw the sides of the pillow 
pretty firmly up against it. (See Fig. 3.) A light piece 
of board, or several such pieces, may be bound on 
afterward to secure greater steadiness, or the other 
leg may be used as a splint, by binding the injured 
one to it. 

In fracture near or at a joint it is best to bend 
the joint a little, and lay the limb flat on a pillow, 



FRACTURES — BROKEN BONES. 



51 



keeping it cool and moist. These breaks are espe- 
cially grave, and demand the best skill that can be 
obtained. 

Fractures of bones that lie deep in the body, 
like the hip bone or the shoulder blade, are fortu- 
nately very rare. They are hard to detect, and can 
be treated only by placing the sufferer in a comfort- 
able position and securing rest and coolness till a 
surgeon comes. 

Fractures of the ribs must be treated in the 
same way. It is a good plan, however, to put on the 
side of the chest where the break is, long strips of 
sticking plaster, about two inches wide, placed par- 
allel to the ribs, beginning at 
the lowest part of the chest 
and going up, each strip be- 
ing made to overlap the one 
below about half its width. 
The strips should extend from 
the spinal column to the mid- 
dle of the breast bone. This 
makes the chest wall more 
rigid and prevents the rubbing 
together of the broken ends of the bone. (See 
Fig. 40 

In fracture of the collar-bone the patient 
should be laid on his back, on a hard, flat, hair 
mattress, or on a settee, with a folded blanket 
under him (never on feathers), without any pillow, 




Fig. 4. 



52 



ACCIDENTS AND EMERGENCIES. 



and kept so until the surgeon comes. This is one of 
the best ways to treat a broken collar-bone until it is 
quite healed. 

In fracture of the jaw, close the mouth and 

put a bandage round, so as 
to keep the two rows of teeth 
against each other. (See 

Fig. SO 

In fracture of the skull 

there is nothing the non- 
medical can do better than 
to place the patient on his 
back, and to apply cold, wet 
cloths to the head. 

Fractures of the spinal 
column (broken back) are 
very hard to detect, but if 
one be suspected the patient must be moved as little 
as possible. He had best be laid out upon his back, 
and, if possible, not be disturbed till the surgeon 
directs it. Turning such a patient over upon his 
face is dangerous, and must not be permitted. 

Compound fractures, as has been remarked, 
are those in which there is an open wound commu- 
nicating with the broken ends of the bone. They 
are to be treated, in an emergency, like simple frac- 
tures in the same locations, with the additional 
precaution that they must be thoroughly cleansed 
and kept clean, and the greatest care exercised to 




Fig. 5, 



FRACTURES BROKEN BONES. 53 

keep the sharp edges of the bone from doing any- 
further damage. 

In all fractures cloths dampened in cold water 
may be applied to the surface, so as to prevent, as 
far as possible, the swelling which usually comes on 
soon after a fracture, and which often interferes very 
much with the examination of the surgeon. 

Splints. There is nothing in which there is a 
greater call for ingenuity and fertility of resource 
than in extemporizing splints for broken bones. 
Pasteboard, leather, shingles, pieces of cigar box — 
anything fairly smooth and stiff, may be used. A 
surgeon at the seashore got himself no little credit 
once by setting a broken arm on the beach, folding 
up and using as a splint a large newspaper which he 
had been reading. The chest usually serves as a 
very good splint for the arm ; and when a leg is 
broken, the other one will make a good temporary 
splint, or a coat-sleeve, or leg of a pair of trousers, 
stuffed with grass or hay, may prove serviceable. 



54 ACCIDENTS AND EMERGENCIES. 



Wounds. 



In studying wounds we will adopt the classifica- 
tion customary in works on surgery, viz. , contusions, 
contused, lacerated, punctured, poisoned, incised 
and gunshot wounds. 

Contusions are what are usually known as bruises, 
and almost all wounds of the soft tissues caused 
by blows. They are sometimes very painful, and 
often followed by discoloration, due to the escape 
of blood under the skin from the small vessels of a 
part. A black eye is a familiar example of this sort 
of an injury. 

They are sometimes very simple, as in the illus- 
tration just given. Such contusions are best treated 
at first, when painful, by the application of cold, 
wet cloths. Pure laudanum is often a very accept- 
able application. Later, when the pain has subsided, 
hot, wet cloths are best, as they favor the carrying 
off of the blood that has escaped. 

Contusions of the chest or abdomen may be 
very serious, for beside the external bruises, important 
internal organs may be injured. Evidence of this 
may be seen in spitting of blood or vomiting it, or 
passing it from the bowels or from the bladder ; or 
there may be great depression. In such cases little 



WOUNDS. 55 

can be done by the non -professional person beyond 
securing complete rest and sustaining the strength of 
the sufferer by means of warmth applied externally 
and careful stimulation internally, as described in 
speaking of Shock — to which reference may be 
made (page 66), 

Contused wounds. These are cuts or tears 
accompanied with bruising of the tissues. They are 
to be treated like lacerated wounds. Unless they 
bleed freely, warm applications are better suited to 
such wounds than are cold ones. 

Incised wounds, or clean cuts, if simple and 
small, call only for a piece of sticking plaster, and 
perhaps a bandage. If large, the edges should be 
brought as near together as possible, and supported 
so by sticking plaster, or bandages, or the hands, till 
the coming of the surgeon. If an entire part be cut 
off, as an ear, or a nose, or a toe, or a finger, it 
should be cleaned with lukewarm water, and put in 
its place, leaving to the surgeon the decision whether 
or not it be worth while to try to save it. Some 
very remarkable cases of reunion of such parts are 
on record, and an attempt to save them is not to 
be lightly rejected. 

Cuts of the walls of the abdomen are often 
followed by escape of a portion of the bowels. These, 
if dirty, should be cleansed, and a gentle effort made 
to restore them to their place. If this fails they 
should be covered with a clean white cloth, soaked 



56 ACCIDENTS AND EMERGENCIES. 

in warm water and kept warm and wet by a gentle 
stream of water, or by laying on it a sponge soaked 
in warm water, which should be constantly renewed. 

Cuts of the chest wall may be followed by 
escape of a portion of lung. This should be treated 
in the way just described for escaped bowel. 

Cut-throat wounds usually require, in addition 
to the ordinary treatment of the wound, that the head 
shall be bent forward, with the chin close to the breast 
bone, and kept there. 

The way to wash delicate structures, such 
as the intestines, or raw cut or torn surfaces, may 
be described here — and it is a good plan to learn 
to do such things by practicing them before the 
emergency arises. Dip a sponge in water, and hold 
it in the closed hand, with the thumb uppermost, 
and a corner of the sponge hanging below the 
fist. Now, on squeezing it regularly, a single stream 
of water will flow softly and steadily down from it. 
The size of this stream can be regulated by the way 
the sponge is squeezed ; its force, by the height to 
which the sponge is raised. This is the only way of 
cleaning off delicate tissues that is safe in the hands 
of the unexpert. 

Lacerated wounds are tears with ragged edges, 
such as are often caused by machinery, bricks, clubs, 
timbers, stones, dull tools, glass, hooks, etc. These 
always require surgical skill. Till it can be ob- 
tained, however, the torn parts can be placed in as 



WOUNDS. 57 

nearly their natural position as possible (after re- 
moving, with a stream of lukewarm water, squeezed 
from a sponge, any foreign matters that can be so 
gotten rid of) and covered with a cool, wet cloth, or 
a cloth soaked in laudanum, or alcohol. If the tear 
has been very great, and the sufferer is depressed and 
cold, teaspoonful doses of brandy or whisky, in hot 
water, may be administered, and a cloth wrung out 
of hot water placed over the injured parts. 

Punctured wounds are made with sharp- 
pointed objects, like arrows, pins, needles, tacks, 
fish-hooks, glass, thorns or splinters. Of these 

Pin wounds rarely do much harm. 

If a needle is run into the flesh and comes out, 
always see that it is all there ; and if any part, from 
point to eye, is missing, call a surgeon. Meanwhile 
keep the wounded part perfectly still, and make no 
attempt to remove what remains. This would pro- 
bably be quite in vain, and would only increase the 
difficulty of the surgeon's work when he arrives. The 
broken needle should be carefully kept and shown to 
him, as he will then know better what to look for in 
his examination. 

A fish hook is a disagreeable thing to get in one. 
If this should happen, the best thing to do is to cut 
off the string, push the point of the hook through, 
and draw it out, like a needle in sewing. If it can 
be done, the broad part of the hook may be cut off 



58 ACCIDENTS AND EMERGENCIES. 

before trying this. But this is usually not easy for 
the operator or the patient. 

Thorns rarely do much harm unless they are 
poisonous, and poisoned wounds we shall consider 
later. 

Splinters are dangerous in proportion to their size 
and according to the part they enter. Small splinters 
may be picked out with a needle. 

Splinters under the nails sometimes defy at- 
tempts at removal by the non-medical. But the way 
to succeed is to scrape the nail as thin as possible over 
the splinter, then to split it, or cut a little tongue out, 
and remove the splinter. Often when, after this, the 
splinter cannot be removed, it will yet come away of 
itself when matter forms ; and in any case the sufferer 
will be much better off for submitting to this little 
operation. 

Splinters of glass are quite beyond most 
peopled skill. They are best treated with cold, 
wet applications, and left otherwise entirely to the 
surgeon. 

Splinters in the eye should be pulled out, if 
possible. If not, the eyelid had better be gently 
closed, both eyes covered with a layer of cotton 
soaked in cool water, and a bandage placed round 
the head, so as to keep the lids as still as possible. 
This bandage should not be too thick or put on too 
tight, and the application should be kept cool, with 
ice, if need be. 



WOUNDS. 59 

If a large splinter enters the body, an attempt 
may be made to pull it out ; but a surgeon should 
be called without fail, and whatever of the splinter 
has been extracted carefully saved and shown to him. 
This will aid him in making up his mind whether 
or not the removal has been complete, and perhaps 
save much pain and danger to the patient. 

Poisoned wounds may be considered here, as 
they are usually punctured, and result from the bites 
or stings of animals or insects. 

The bites of venomous serpents usually 
demand the prompt removal of the part bitten. It 
may be cut out instantly by any one who has the 
nerve to do it. Before this, perhaps, the part should 
be encircled, above the wound, with a tight ligature, 
and, if small enough, thrust into the mouth and 
sucked hard, so as to extract the poison. The imme- 
diate application to the wound of hartshorn is of 
advantage ; and a knitting-needle, or nail, heated to 
redness, may be thrust into it. At the same time, 
whisky should be given, in doses large enough to 
cause drunkenness, and the intoxication kept up till 
medical aid can be secured. 

The stings of tarantulas, scorpions, centi- 
pedes, etc., are to be treated with cold, and harts- 
horn applied to the point where the sting entered. 

The stings of insects are rarely dangerous to 
life. They may be treated with cold, wet applica- 
tions — wet earth is a very good one. The applica- 



60 ACCIDENTS AND EMERGENCIES. 

tion of a drop of hartshorn or some wet salt often 
gives great relief. 

The bites of cats and rats are sometimes fol- 
lowed by severe inflammation ; but the first treatment 
should be simply cleansing the bites, sucking them, 
perhaps, and applying cold to them for a time. 

The bites of dogs are a terror to many people, 
while others have little fear and are very seldom 
bitten. Dogs seem to learn who do not fear them. 
If any one be bitten by a dog in good health, only 
the simplest treatment will be necessary. If the dog 
be sick, local inflammation, or severe constitutional 
disturbance may follow. In case of reasonable sus- 
picion, the wound may be thoroughly cleansed and 
an application of hartshorn made to it, in addition 
to energetic sucking to extract any irritating material 
which may have entered it. Of course, too, sound 
medical advice will be taken. 

It is a most foolish thing to kill a dog that has 
bitten anybody, soon after this has taken place. Such 
a dog should be caught and kept under the observa- 
tion of a person of great carefulness, intelligence and 
special information. The too speedy slaughter of a 
dog has robbed many a sufferer of the assurance that 
would have been gained by seeing it living and well, 
and sent many a one to the grave, as dying of hydro- 
phobia, who never had it, but had been bitten by a 
healthy and harmless animal. 

Again, if one has been bitten, and there be a rea- 



WOUNDS. 61 

sonable suspicion that the dog was "mad," let him 
not despair. Some of the most able and careful 
(that is the greatest matter) medical men are of the 
opinion that most, if not all, cases of so-called hydro- 
phobia, are spurious ; that is, they are not hydrophobia 
at all. I have myself studied this subject with great 
care for years, and have become satisfied that the 
popular theory in regard to hydrophobia is utterly 
wrong. In most of the reported cases the patients 
have been alarmed by what they thought, and 
frightened by what injudicious friends or timid 
doctors have said and done, until they died of sheer 
terror. So, in case of a bite from a supposed mad 
dog, let the things suggested above be done ; then 
let quiet be secured, and the very best medical man 
in the place sent for. It is a very serious matter, and 
calls for the clearest head and most extensive in- 
formation. Whoever gets flurried and shows alarm 
at such times is scarcely less dangerous than the dog 
that did the biting. Then let no one breathe 
"hydrophobia," or talk about what has happened. 
By this the chances of escape will be increased.* 

Gunshot wounds. This is another class of 
injuries occasionally met in civil life, though not 
common. Ordinarily little can be done for them, 



* The author calls attention to the fact that so-called hydrophobia exists 
exactly in proportion to the common belief in it. It seems to have disap- 
peared from Pennsylvania, and is extremely rare in any part of the United 
States. 



62 ACCIDENTS AND EMERGENCIES. 

except by a surgeon ; and perhaps all that is advisable 
before he comes is to note and remember the posi- 
tion of the body or the wounded part at the moment 
it was struck, and the direction from which the 
missile came, so that these facts may help the surgeon 
in his search for it.* Then col4 wet cloths, upon 
which laudanum may be poured, should be kept 
upon the wound, to prevent, as far as possible, 
inflammatory swelling ; and if, as is very often the 
case, the patient be in what surgeons call a state of 
shock — that is, cold and depressed — stimulating doses 
of wine, whisky or brandy should be given, and 
heat applied to the surface of the body. If a part 
is badly shattered, the local treatment should be the 
same, except that, if there be much depression, 
cold had better not be used at all. There is rarely 
much bleeding from gunshot wounds, except when 
large vessels are divided. In such a case the bleed- 
ing may be controlled as described under the head 
of hemorrhage. 



* To show how strange may be the course of a bullet, I will cite a case 
which I treated in 1876. A young man was shot with a pistol. The ball 
passed through his lower lip, struck an upper front tooth, which it broke off, 
then glanced downward and backward, diagonally through the tongue, 
and finally buried itself in the floor of the mouth, on the other side from 
that where it entered the lip. 



RAILROAD AND MACHINERY ACCIDENTS. 63 



Railroad and Machinery Acci- 
dents. 



Railroad and machinery accidents may be 

the occasion of simple incised, contused or lacerated 
wounds, or, as is very common, of severe tears, 
wrenching off of fingers or toes or limbs, or of 
crushes. Saws, planing machines, cog-wheels, belts, 
and many other machines or parts of machines, 
cut or tear off many a limb or part of one. Such 
injuries almost always occur when no medical aid 
can be obtained for some time, and it would be 
well if some one on every train and in every room 
or place where machinery is in motion could have 
some idea of what can be done, and what cannot, 
before a doctor can be had. 

Trifling injuries, whether cuts or tears, are to 
be treated on the principles already described in 
speaking of incised or lacerated wounds ; that is, 
the parts are to be cleaned as gently and as well as 
possible, by letting lukewarm water run over them. 
Then, any displaced tissue — skin or flesh — may be 
put in place, and a clean, white cloth, soaked in 
laudanum or alcohol or water, laid upon the wound, 



64 ACCIDENTS AND EMERGENCIES. 

and bound on loosely with an extemporized band- 
age. 

Hemorrhage is not usually severe after railroad 
and machinery accidents, because the wounds are 
generally inflicted in a way which closes up the 
blood vessels as they are torn or twisted off. 

Large tears, or lacerations, must be treated 
by carefully removing any fragments of clothing, or 
dirt or splinters of any sort, and washing with luke- 
warm water. For removing foreign matters, the best 
forceps are in everybody's possession. They are a 
finger and thumb ; and no one need be afraid to 
use them with reasonable care. They may be aided 
occasionally by touches with a clean linen or muslin 
cloth, or a clean sponge; but these must be un- 
doubtedly clean. 

After cleansing is complete, the torn parts must 
be put in position, and kept so by bandages, sticking 
plaster, or the hands of another person, as may 
seem best. Sometimes a splint is required. This is 
usually easy to prepare in a mill or on a railroad. 
It may be clumsy — that is not of much consequence 
— but it ought to be sufficiently large to keep not 
only the injured part still, but, in case of a limb, the 
joint above and the joint below the injury. 

Such injuries are often accompanied with com- 
paratively little pain. If, however, there should be 
severe pain, laudanum may be given — about thirty 
drops to an adult. Cold or hot cloths — whichever 



RAILROAD AND MACHINERY ACCIDENTS. 65 

are most comforting — must be applied to the 
injury. 

When fingers or toes are crushed they ought 
to be washed, modeled into good shape, dressed with 
a piece of soft white cloth which has been wrung out 
of hot or cold water, and laid upon a small splint. 

If a finger or toe hangs by a mere shred, snip it 
off entirely. Because, although such fingers and 
toes have been saved, such a result' is almost miracu- 
lous, and the cost, in time and trouble and money, 
is more than a finger is worth to a workingman, and 
indeed to almost anybody. 

When fingers or toes are torn off the stumps 
almost invariably require a scientific amputation. 
But, until this can be decided upon, they must be 
cleansed, and treated with a cool, wet application of 
some sort, and then not meddled with. 

Hands or feet that have been crushed must 
be treated by being wrapped up in some soft warm 
dressing, like cloth, or cotton, or wool. Cold is 
only to be used if there be profuse bleeding. The 
injured part must invariably be supported with some 
sort of a splint and placed about on a level with the 
body. One who has received such an injury ought 
to be made to lie down, unless some other course is 
absolutely necessary for moving him, or is authorized 
by a surgeon. Such injuries rarely cause much pain, 
but they almost invariably cause great depression. 
This must be met by keeping the sufferer warm with 



66 ACCIDENTS AND EMERGENCIES. 

wraps and hot cans or bricks, or bottles, and giving 
him, every few minutes, a small quantity of whisky 
or brandy (a teaspoonful) in a little hot water. 
Larger doses of spirits are not needed. (See Shock.) 

When hands or feet have been torn off or 
cut off with wheels, the stumps are to be treated as 
described, and the limb placed in such a position 
that the injured point is higher than any other. 
These injuries are usually accompanied with depres- 
sion also, and this is to be combated in the manner 
just described. 

Crush of the arms or legs is to be treated like 
crush of the hands or feet. But here the prostra- 
tion is usually much greater and the need for sup- 
port, with warmth and stimulants, more urgent. 
The clothing should on no account be disturbed, 
except in so far as it can be cut away and replaced 
with warm coverings. 

Crushes of the chest are sometimes instantly 
fatal, and almost always cause death in a short time. 
In such cases, as well as in case of 

Crushes of the lower part of the body, there 
is nothing that can be done beside securing rest, 
warmth and moderate stimulation. The sufferer 
should be made as comfortable as possible, and 
prepared for the almost inevitable issue. 

Shock is a condition which has been alluded 
to already, in speaking of certain injuries. It may 
also be caused by fright, as, for example, that which 



RAILROAD AND MACHINERY ACCIDENTS. 67 

may accompany a trifling gunshot wound. Or it 
may be caused by a blow upon the pit of the stomach, 
or by a sudden and severe pain, or even by drinking 
a large quantity of ice-cold water. It is very com- 
mon after gunshot wounds, and almost invariable 
after serious railroad or machinery or mining acci- 
dents. 

The signs of shock are : great paleness, a cold, 
clammy skin, a very feeble pulse and feeble breath- 
ing, a pinched face, dull eyes, drooping eyelids, 
dilated pupils, bewilderment or dullness of mind, or 
even insensibility. A person in such a state may die 
very soon, and will surely die before long, unless he 
can be brought out of the shock. This requires 
prompt, energetic and persistent effort on the part of 
those who come to his assistance. Heat must be ap- 
plied, if possible, to the whole body, and especially 
to the region of the heart and pit of the stomach. 
This can be done with a hot bath, a hot fire, 
hot cans, hot bottles, stove plates, heated blankets 
— in fact, anything hot that can be got hold of. 
At the same time hot drinks, to which brandy or 
whisky has been added, may be given in small and 
frequently repeated quantities. To be more exact, a 
teaspoonful of brandy or whisky in a tablespoonful 
of hot water may be given every ten minutes for 
several hours. 

Manufactories, mines and railways ought to be 
furnished with appliances for the treatment of this 



68 ACCIDENTS AND EMERGENCIES. 

condition and some one who knows how to use them ; 
for shock almost always follows severe accidents oc- 
curring to their employees, and is the most common 
cause of death after them, as any hospital surgeon 
could testify. 



HEMORRHAGE — BLEEDING. 69 



Hemorrhage — Bleeding. 



There is no accident so appalling as hemorrhage, 
whether the bleeding comes from an external wound 
or from the rupture of blood vessels in some internal 
organ. There is none which calls for so much nerve 
in combating it, nor any in which a little accurate 
knowledge can be more valuable. 

The subject of the control of hemorrhage will be 
better understood after taking a concise view of the 
anatomy of the organs of circulation. This cannot 
be made absolutely accurate without being too techni- 
cal, but the variations from accuracy will not affect 
its practical utility. (See Frontispiece.) 

The blood starts from the left side of the heart, 
and is driven first into the aorta, which curves over 
above the heart and descends along the left side of 
the spinal column, within the chest and abdomen. 
From what is called the arch, at the beginning, are 
given off the vessels which supply the head and arms. 
The former (the carotid arteries) run up alongside 
the windpipe and divide and subdivide in all direc- 
tions. The latter curve forward and come out from 
the chest over the first rib, and, passing under the 
collar bone near the shoulder, run down through 



70 ACCIDENTS AND EMERGENCIES. 

the armpit and inside of the arm to the middle of 
the front of the elbow, and here divide into two 
branches. One of these passes along the front of 
the forearm, on the thumb side, and the other along 
the little finger side. Thus, in the upper arm the 
arteries follow nearly the same line as the seam in 
a coat-sleeve. The two arteries of the forearm, 
entering the palm of the hand, join in a loop, from 
which vessels run down, one on each side of each 
finger, and one on the inner face of the thumb. 

The aorta, as it descends through the chest and 
abdomen, gives off vessels to supply the internal 
organs, and near the lower end of the backbone 
divides and sends two large vessels out through the 
groin into the thigh. Each of these runs down in 
almost a straight line, between the muscles, to 
the middle of the hollow at the back of the knee. 
Just below this it divides into three branches. The 
first of these passes through to the front, between 
the two bones of the lower leg, and runs down 
under the muscle, close to the outer side of the shin 
bone, and passes out upon the instep at about the 
middle of the front of the ankle joint. Here it 
breaks up into smaller vessels that supply the top of 
the foot. 

The second and third branches of the main artery 
of the thigh pass down the back of the lower leg, one 
on each side, close to the corresponding bones,. and 
deep under the muscles. One passes back of the 



HEMORRHAGE — BLEEDING. 71 

inner ankle bone into the inner side and sole of the 
foot. The other passes back of the outer ankle 
bone, to the outer side and sole of the foot. The 
arteries of the sole of the foot, like those of the palm 
of the hand, unite to form a loop, from which a 
vessel is given off for each side of each toe. 

This is a brief outline of the course of the arteries. 
As they divide and subdivide, like the branches of a 
tree, they become correspondingly smaller, and they 
end in an inexpressibly fine network of minute ves- 
sels. These are called capillaries. Then, as the capil- 
laries are a sort of splitting up of the smallest arteries, 
so, on the other hand, by the confluence of a number 
of capillaries, larger trunks result, toward which the 
current of blood constantly sets, and the beginnings 
of the veins are formed. These unite in a manner 
the very reverse of the branching of the arteries, and, 
growing, like rills and brooks and rivers, larger and 
larger by repeated junctions of several into one, 
travel back to the heart in an opposite direction to, 
but alongside of, the arteries. Thus each principal 
artery has at its side at least one important vein. Up 
the legs, up the inside of the abdomen and chest, 
up the arms and down the neck they pass, till they 
unite to form one trunk, which empties into the right 
side of the heart. 

From this point the blood is pumped into the 
lungs to be aerated ; from the lungs it is collected 
and emptied into the left side of the heart ; and 



72 ACCIDENTS AND EMERGENCIES. 

from the left side, as we have seen, it is pumped 
out to begin the circuit through which we have just 
traced it. 

The diagram in the frontispiece will give a fair 
idea of the course of the main blood vessels, and 
will make clearer what may not have been under- 
stood from the preceding description. 

It will be observed that the course of the blood 
vessels is always in the safest part of the body or 
limb. They all lie where they are protected by 
bending a limb or a joint — a natural act when 
attacked. They are on the inner side of the arm 
and forearm, when these are used for attack or 
defence. They are on the inner side of the thigh 
and at the back part of the leg — out of harm's way. 
In endeavoring, as shall hereafter be recommended, 
to check bleeding by pressing upon a main blood 
vessel, this fact may serve as a reminder of the 
course it might be expected to run. To which this 
suggestion may be added, namely : When you are 
in doubt, feel for the pulsation of the artery and 
make pressure where you feel it beating. Another 
point, preliminary to considering the methods of 
arresting hemorrhage, is that blood from arteries is 
usually bright red and escapes in jets, while blood 
from veins is dark red or purple, and flows in a 
steady stream. Blood from capillaries is of a color 
between these two, and it oozes out. 

Capillary hemorrhage follows every cut. The 



HEMORRHAGE — BLEEDING. 73 

color of the blood is red ; the flow is generally slow 
and not very considerable. It usually stops of itself. 
If it does not, the part may be elevated and cold 
water or ice or snow, or even vinegar, applied. If 
there is oozing from a large raw surface, a towel may 
be folded, dipped in water as hot as the hand can 
possibly bear, lightly squeezed, so as not to drip, 
and gently pressed upon the bleeding surface. This 
may have to be renewed once or twice, at intervals 
of a few minutes, but it usually acts like magic in this 
form of hemorrhage. 

Hemorrhage from the veins is generally slow 
and steady, and the blood is darker than in other 
forms. It rarely demands special effort to control it. 
When severe, the application of cold, and firm con- 
tinuous pressure upon and below the wound, generally 
suffice to stop it. Rupture of varicose veins in the 
leg may lead to dangerous hemorrhage, but this can 
usually be checked by applying a dry pad of cloth 
and binding it firmly down upon the bleeding spot. 
In this case a ligature applied above the wound 
would only make the matter worse. 

A wound of the jugular vein, on the side of the 
neck, may also be followed by dangerous hemor- 
rhage. This is also to be treated with a pad and 
pressure, which can be best made with one finger laid 
above and one below the wound. 

Hemorrhage from the arteries is very danger- 
ous. Here the blood is bright red, and spurts in a 

F 



74 ACCIDENTS AND EMERGENCIES. 

stream or leaps in jets from the divided vessel. If 
it be from a large artery, such as those in the root of 
the neck or the armpit, or the inside of the thigh 
near the groin, life will usually be quickly lost. 
Indeed, without a thorough acquaintance with 
anatomy, it is hardly likely that any advice that 
could be given here would be available in such cases. 
The only thing to suggest is to thrust a finger deep 
into the wound and see if firm pressure there will 
stop the bleeding. Or some other form of plug may 
be tried. The chances of success are, however, very 
slight. 

But every one may, while awaiting skilled aid, 
do something when the arteries of the limbs are cut. 
The first duty in all such cases is to be cool as pos- 
sible, then, as quick as is consistent with coolness. 
The principle that must guide every attempt to stop 
the bleeding is to obstruct the artery at the spot, or 
between the centre of the body and where it is cut ; 
for this is the direction in which the blood flows. 

For wounds high up in the arm, strong pres- 
sure may be made downward, behind the collar 
bone, about at its middle (see Fig. 7). The thumb, 
or the handle of a large door key, well wrapped, so 
as to make a tolerably thick mass, can be thrust 
down, and if it does not seem to strike the artery the 
first time, it can be moved along, toward the breast 
bone and toward the shoulder, to see if it will hit 
the right place. 



HEMORRHAGE — BLEEDING. 



75 



For wounds of arteries of the finger, pres- 
sure may be made on the side, by seizing it between 
the thumb and finger and pinching it, or by wrap- 
ping a cord round, or slipping on a rubber band. 

For wounds of arteries of the hand, raising 
this above the head and making firm pressure on the 
bleeding spot, or with both thumbs just above and in 
front of the wrist, will usually stop the bleeding. Or 
the wound may be packed with lint, or cotton, or 
old muslin, or linen, and bound firmly with a band- 
age. If this fail, resort must be had to the 
measures recommended for the next form of hemor- 
rhage. 

For wounds below the elbow, first grasp the 
upper part of the arm with both hands and squeeze 
as hard as possible ; then let some one make a thick, 
hard knot, as big as an egg, in the middle of a hand- 
kerchief, place it over the 
middle of the front of the 
arm, immediately above 
the elbow, tie the ends 
tight at the back, and bend 
the forearm up so as to press 
hard against the knot (Fig. 
6). This, if successfully 
done, will obstruct the main 
blood vessel (the brachial Fig. 6. 

artery), which in this place lies in the middle line of 
the bend of the elbow. 




76 



ACCIDENTS AND EMERGENCIES. 



For wounds in the upper arm, pressure may 
be made against the bone on the inner side and just 

below the swelling 
muscle, which most 
people are aware is 
called the biceps, as 
shown in Fig. 7. A 
knot as big as a fist 
may be made in any 
piece of cloth and 
shoved hard up into 
the armpit, and the 
elbow then brought 
straight down and 
held or bound firmly 
against the side of 
the chest. 

If either of these 
methods fail, or can- 
not be carried out, the " Spanish-windlass ' ' may be 
used. To do this, place some hard, round body, like 
a stone, in the large part of a handkerchief folded 
diagonally, and carry the ends of this round the 
limb, so as to leave the lump over the position of the 
artery — that is, over the bend of the elbow, or a little 
in front of the middle of the inside of the arm, near 
the shoulder. Then tie the ends of the handkerchief 
so as to make a loose loop, slip a stick through this 
and twist it round and round, so as to tighten the 




Fig. 7. 



HEMORRHAGE — BLEEDING. 



77 



handkerchief, till the blood stops flowing but no more / 
This is a much rougher procedure than the method 
described before, but one cannot be over-particular 
in such cases ; so if the former fails, or no bystander 
is cool enough to carry it out, -no time must be lost 
before the " Spanish-windlass ' ' is used. 

Wounds of arteries of the foot or leg may 
be treated by firm pressure in the hollow just behind 
the knee (above the calf of the leg). This can be 
effected by placing there a 
knotted cloth, like that sug- 
gested for the armpit, and 
doubling the leg back until 
it presses hard against it. In 
doing this, the thigh must 
be doubled up toward the 
abdomen or the bending of 
the knee will soon become 
intolerably painful. 

For wounds in the 
thigh, pressure must be 
made in the hollow imme- 
diately below the groin, 
about two-thirds of the way 
from the hip bone to the 
middle line of the body, 
where the artery of the thigh 
(femoral artery) comes out of 
the body, as shown in Fig. 8. FlG 8 




78 ACCIDENTS AND EMERGENCIES. 

This can be effected with the thumbs or with a rounded 
stick, or a key handle, or with a " Spanish-windlass.' ' 
The artery may also be closed by placing in the 
groin a knotted cloth, or a large round stone, and 
doubling the leg back on the thigh (this is important), 
and the thigh forward, hard against the abdomen. 
If this latter plan does not succeed promptly some 
other one of those mentioned should be tried, and no 
time be lost in doing it. 

Bleeding from arteries of the scalp can be 
controlled by firm pressure upon and around the 
bleeding point. 

Recapitulation. — To go over this briefly again ; Re- 
member : first, to keep cool ; second, that the princi- 
pal object is to obstruct the artery above the cut ; and 
that this can be effected by pressure, in the several 
cases, in front of the bend of the elbow, in the armpit, 
behind the bend of the knee, or just below the groin. 
This can be made with the fingers, or with a knot, 
held hard against the artery by a tight bandage, or 
by bending the limb up against it — or, in case of the 
arm, by pressing it hard against the chest. In case 
of failure, the " Spanish-windlass ' ' is to be applied 
to the same places. 

In case none of the plans proposed can be carried 
out, a cut that bleeds profusely may be stuffed with 
a rag or dry earth, and this kept in place by pressure, 
with a bandage or handkerchief, or the cut part may 
be forcibly compressed in any way, or a finger thrust 



HEMORRHAGE — BLEEDING. 79 

into the wound and held wherever it seems to do 
most good. 

Finally, let it be remembered that fainting may 
put an end to hemorrhage, and that when con- 
sciousness is restored the bleeding may recur. So 
this possibility should not be overlooked. The treat- 
ment of a faint under these circumstances is the same 
as that of any faint : in addition to the measures 
demanded to check the bleeding, the head must be 
lowered, the legs and arms may be elevated, and 
warmth applied to the body, while stimulants are 
carefully administered by the mouth. 



80 ACCIDENTS AND EMERGENCIES. 



Special Hemorrhages. 

Bleeding from the nose is often only Nature's 
way of getting rid of an excess of blood ; but it may 
be so profuse as to threaten life. If this be the case, 
of course, medical aid will be summoned ; but until 
it arrives the best thing that can be done is to snuff 
salt and water, or vinegar, up the nose. A strong 
solution of alum in very warm water is also useful ; 
but vinegar is less disagreeable, and will rarely fail to 
check the bleeding, unless the case is beyond any 
except skilled help. 

In hemorrhage from the lungs the blood is 
bright red and generally frothy. It is rarely pro- 
fuse, and yet, as it is usually coughed up and caught 
in a handkerchief, it seems to be so. The amount 
can never be safely estimated in this way. The best 
treatment is rest in bed, with the body raised in the 
sitting posture, and the swallowing of lumps of ice. 
The application of cold to the chest, if the patient 
is not too weak, is of some use, and a saltspoonful of 
salt and a teaspoon ful of vinegar may be given every 
fifteen minutes. 

In hemorrhage from the stomach the blood 
is usually very dark, looking like coffee grounds. 



SPECIAL HEMORRHAGES. 81 

If it is mixed with any other contents of the stomach, 
its appearance may be masked. In such cases ice 
water or broken ice may be swallowed, and tea- 
spoonful doses of vinegar. Rest in bed must, and 
the application of cold to the stomach may, be em- 
ployed. 

Hemorrhage from the bowels may be treated 
with ice-water injections and the application of ice 
to the abdomen. 

In internal hemorrhage ice-cold cloths may 
be placed upon the abdomen. Rest in bed, with- 
out a pillow, and with the head lower than the body, 
must also be secured. 



82 ACCIDENTS AND EMERGENCIES. 



Transportation of Injured Per- 
sons. 



If injured persons have to be removed from one 
place to another, it is worth while to know how to 
do it with the greatest ease and safety to them. If 
a door, or shutter, or settee is at hand, any of these 
will make a good litter, with a blanket, or shawls, 
or coats for pillows. In placing a person upon a 
stretcher it should be laid with its foot at his head, 
so that both are in the same straight line. Then 
one or two persons should stand on each side of 
him, and, raising him from the ground, slip him up 
on the stretcher. This can be done smoothly and 
gently, whereas, if a stretcher is laid alongside of 
an injured person, some of those who lift him will 
have to step backwards over it, and in doing so are 
very apt to stumble. In going up hill the patients 
head should be in advance, in going down hill, his 
feet. If a limb is crushed or broken it may be laid 
upon a pillow, with bandages tied round the whole, 
so as to keep it from slipping about (see page 50). 
Where an injured person can walk, he can get much 
help by putting his arms over the shoulders and round 



TRANSPORTATION OF INJURED PERSONS. 



83 



the necks of two others. In case of an injury where 
walking is impossible and lying down is not abso- 
lutely necessary, an injured person may be seated on 
a chair and carried, or he may sit upon a board or 
fence rail, the ends of which are carried by two men, 
around whose necks he should place his arms, so as 
to steady himself; or two men may carry him seated 




Fig. 9. 




Fig. 10. 



on their interlocked hands, in the way known to 
children as "Lady to London.' ' To do this, each 
of two persons, standing face to face, should grasp 
his right forearm with his left hand (its back upper- 
most), then he should grasp his companion's free 
left forearm with his own free right hand (also with 
its back uppermost), as shown in Fig. 9. When no 



84 



ACCIDENTS AND EMERGENCIES. 



litter can be gotten, the body may be supported by 
a man on each side, with their arms placed behind 
his chest and under his hips, as in Fig. 10. In carry- 




FlG. XI. 



ing an injured person upon a litter, or what serves for 
one, the bearers ought not to keep step ; but when 
they are not using a litter, they should keep step. 



\ 



poisons. 85 



Poisons.* 



Immediately upon the discovery or suspicion of 
poisoning, some one should be dispatched for a doc- 
tor, if possible, carrying information as to the poison 
taken, so that valuable time may be saved. Mean- 
while the following may be done : — 

i. Unknown Poisons. If the patient should 
vomit, this should be encouraged; if not, it must 
be provoked. The simplest way to do this is to 
give large draughts of lukewarm water, and thrust 
a finger down the throat. If there be time, and it 
is at hand, a teaspoonful or two of ground mustard 
may be stirred up in the water, or a teaspoonful 
of powdered ipecac, or a tablespoonful of the syrup 
of ipecac. Further, let it be remembered that there 
is no occasion for fastidiousness. Any water will do. 
Water in which hands — or dishes, for that matter — 
have been washed, may, by its very repulsiveness, 
act more quickly than anything else ; and if soap has 
been used, it will be all the better for that, as soap 

* It is better to prevent accidents than to correct them. It is a good plan 
to have dangerous articles kept invariably out of reach of children, and to 
have any bottle containing what may be dangerous marked by a ball and 
chain, such as the druggists sell, or by tying a stout piece of tape round its 
neck. This gives warning in the dark as well as in the light. 



86 ACCIDENTS AND EMERGENCIES. 

is an antidote for acid poisons. The quantity used 
must be large ; the sufferer must be urged to drink 
and drink, a large quantity at a time, until he can 
contain no more, and has been made to vomit over 
and over again. 

After copious vomiting, soothing liquids should 
be given — oil, milk, beaten-up raw eggs — all in 
moderately large quantities. These are especially 
valuable when the poison has been of an irritating 
character. 

If the sufferer be much depressed in body or mind, 
the hands and feet cold, the lips blue, the face pale, 
a cold perspiration upon the forehead and about the 
mouth, then some stimulant may be administered. 
Strong, hot tea, without milk, is the best, because it 
is a chemical antidote to many poisons. Strong 
coffee is next in value. To either of these can be 
added brandy, whisky, wine, or alcohol, in tea- 
spoonful doses for an adult, and half as much for a 
child ; the spirits should be mixed with a little hot 
water. Warm coverings are not to be forgotten ; 
and if the depression be great, hot water cans or hot 
bricks, wrapped in one or two thicknesses of blanket, 
should be laid by the side of the chest, or a huge 
poultice placed round the body, or a blanket, wrung 
out of hot water and covered with a dry one. 

2. Acid Poisons. Oil of vitriol (sulphuric acid) 
and nitric and muriatic acids are heavy, sometimes 
yellowish-looking, fluids ; the first, as its name im- 



poisons. 87 

plies, not unlike oil in appearance, but very heavy 
in a bottle. The others are lighter, and give off 
extremely pungent, irritating fumes. All discolor 
anything on which they fall ; the first blackens white 
pine wood, the others turn it yellow. All burn hor- 
ribly and leave no doubt of their caustic nature. 

For these the proper treatment is to give an alkali. 
A tablespoon ful of hartshorn may be mixed with two 
teacupfuls of water, and given ; or almost unlimited 
quantities of soda, magnesia, potash, whitewash, 
chalk, tooth powder, whiting, plaster, soap, or even 
wood ashes, stirred up in water. 

After this should come the provoking of vomiting ; 
then the bland fluids mentioned above should be ad- 
ministered, rest secured and stimulation employed, 
if necessary. 

Oxalic acid comes in small, heavy, bright, color- 
less crystals, making a clear rattle in a bottle or jar. 
For this the best antidote is lime in some form. If 
lime water is at hand, it may be given freely, or 
whitewash, tooth powder, chalk, whiting, or plaster 
from a wall. The latter may be crushed and stirred 
up in water, without regard to the grittiness, which 
will not do any harm. 

Carbolic acid is usually in solution, as a thick, 
clear and dusky fluid. When taken by the mouth 
it causes whitening and shriveling of the mucous 
membrane lining it, with intense burning and then 
numbness. There are also nausea, weakness and 



88 ACCIDENTS AND EMERGENCIES. 

depression, sometimes actual collapse. It is a very 
dangerous poison, because it acts rapidly and be- 
numbs the stomach, so that it is hard to provoke 
vomiting. This must be attempted, however, and 
large draughts of oil, white of egg, magnesia and 
water, or milk must be given. Rest, warmth of the 
body and stimulation must also be secured. 

3. Alkaline Poisons. The strong alkalies are 
ammonia, or hartshorn — which is a clear fluid with 
an unmistakable odor— potash and soda, usually dis- 
solved, and sometimes in the form of lye. Liniments 
sometimes contain these substances, and are swal- 
lowed by mistake. 

The alkalies usually burn intensely. They must 
be combated with an acid. Vinegar can always be 
had, and there is nothing better. It should be given 
undiluted, and a pint at a time, if possible. Lemon 
juice may be used, or even orange juice, though the 
latter is too mild an acid to be of much service, 
unless the oranges are very sour. Vomiting should 
then be provoked, and followed by bland acid or 
oily drinks, rest and stimulation, if necessary. 

4. Metallic Poisons. Arsenic, sugar of lead, 
corrosive sublimate and tartar emetic are not infre- 
quently taken by mistake, because they are used for 
various household purposes. 

Arsenic comes as a white, sweetish powder, often 
used to destroy domestic pests, such as rats and 
roaches. It usually excites vomiting and violent 



poisons. 89 

pain in the stomach. At once large quantities of 
milk, white of egg, or flour and water, or oil and lime 
water must be given. The vomiting must be en- 
couraged or provoked, and dialysed iron given. 
This can now be obtained at any drug store, and 
should be given freely, in tablespoonful doses, each 
dose being followed at once by a teaspoonful of 
common salt in a teacupful of water ; or, if this is 
not at hand, equal parts of sulphate of iron (green 
vitriol) and of carbonate of soda may be dissolved 
in separate cups of hot water and then mixed and 
drunk. Afterward vomiting should be again pro- 
voked, followed by a dose of castor oil. 

Paris green is an arsenical preparation. If taken 
as a poison, it must be treated like simple arsenic. 

Sugar of lead comes in white lumps or powder, 
and calls for vomiting, Epsom salts, milk, eggs, and 
castor oil. 

Corrosive sublimate comes in small, colorless 
crystals, or in a clear solution. If taken, vomiting 
must be provoked, and some form of tannic acid 
given. Strong tea is the handiest thing containing 
this, and its administration should be followed up 
with eggs and milk. 

Tartar emetic, a white powder, is best treated 
in the same way. 

Phosphorus is sometimes chewed off of matches 
by children. It is a poison which acts slowly, and 
affords ample time for securing medical advice. But 

G 



90 ACCIDENTS AND EMERGENCIES. 

five-grain doses of sulphate of copper, dissolved in 
water, may be given, at intervals of ten minutes, 
until vomiting comes on. Then a dose of magnesia 
should be administered ; but no oil 

Lunar caustic is sometimes swallowed. The 
antidote of this is a very strong brine of salt and 
water, given again and again; and vomiting should 
be provoked, until the vomited matters cease to have 
a look like thin milk. 

Iodine, in the form of a tincture, is also some- 
times swallowed by mistake. The antidote for this 
is starch and water. 

5. Vegetable Poisons. The vegetable poisons 
are so often taken in consequence of mistakes in the 
use of medicines, that it is a wise precaution that a 
poisonous drug should always be contained in a 
bottle of peculiar shape, or with something peculiar 
attached to its neck, and that there should also be a 
special place in each house where dangerous reme- 
dies, and such as are intended only for external use, 
should be kept. 

Opium preparations are opium, morphine, laud- 
anum, paregoric, black drop and many poisonous 
nostrums sold as soothing-syrups, pain-destroyers, 
and drops for infants. Their symptoms are deep 
sleep, with narrowing of the pupil of the eye to a 
small circle, which does not enlarge in the dark. 
Here emetics must be used promptly and persist- 
ently, and vomiting produced over and over again. 



POISONS. v 91 

Strong coffee must be freely given as a stimulant. 
So long as the breathing does not fall below ten 
to the minute, there is no immediate danger of 
death ; but opium is a treacherous poison, and 
requires all the skill that can be obtained to combat 
it. The important matter is to keep up the breath- 
ing. The custom of walking a patient up and down 
and slapping him with wet towels is to be deprecated, 
because it adds exhaustion to stupor. If an electrical 
battery can be obtained, and used, it is the best thing 
that can be done. The Faradic current should be 
used, and applied so as to stimulate the sensory nerves 
in the skin, so that they shall excite reflex acts of 
deep breathing. The next best thing is to lay the 
patient upon a lounge and slap his skin with the 
back of a broad brush or with a slipper. This is all 
the rousing that is necessary, so long as the breath- 
ing keeps above ten to the minute. Should it 
fall below this, or if the breathing should cease, 
artificial respiration should be employed. (See 
pages 13-15.) 

Chloral is a damp, colorless, crystalline substance, 
usually seen in solution. Its symptoms and treat- 
ment are the same as those of opium. 

Strychnine is an intensely bitter, white powder. 
It produces stiffness of the jaws, then of the limbs 
and body. It should be treated by provoking vomit- 
ing, giving a purge, and doses of thirty grains of 
bromide of potash, or twenty grains of chloral, or 



92 ACCIDENTS AND EMERGENCIES. 

both, to an adult. The greatest quiet must be 
secured. The poisoned person should be put to 
bed in a darkened room, with doors, windows and 
shutters arranged in a way that shall exclude all 
sights, sounds and draughts, though permitting good 
ventilation. 

Aconite is sometimes contained in liniments, and 
swallowed by mistake. In such a case vomiting 
must be brought on, and followed by the adminis- 
tration of stimulants. Strong coffee may be used, 
hartshorn (a teaspoonful in a teacupful of water), 
wine, whisky, or brandy. The patient will often 
feel a peculiar numbness or tingling in the arms or 
legs, which is an evidence that the poison has 
entered the blood, and makes the attention of a phy- 
sician imperative. If there is depression, warmth 
should be used, as described wjien speaking of un- 
known poisons. 

Hemlock, deadly nightshade, the James- 
town (or jimson) weed, monkshood, and toad- 
stools are sometimes eaten, without knowledge of 
their poisonous character. Tobacco, too, some- 
times causes poisonous effects. All produce deep 
depression, and must be treated with vomiting, fol- 
lowed by stimulation and warmth, very much as in 
the case of aconite poisoning. 

Alcoholic liquors are sometimes taken in such 
large quantities as to be poisonous. When this is 
the case there are evidences of deep stupor or de- 



poisons. 93 

pression. The course to be pursued is to cause 
vomiting, give hartshorn and water (a teaspoonful in 
a teacupful), and keep the body warm. (See page 
33. Intoxication?) 

6. Decayed meats or vegetables usually excite 
vomiting, which should be encouraged till the stomach 
is empty, and followed by a dose of castor oil and 
some powdered charcoal. 

Resume. We have now completed the list of 
poisons that are at all common, and have seen what 
should be done in almost any case that is likely to 
occur. In conclusion, let it be remembered that, 
when there is an alarm of poisoning, some one, at 
least, must keep cool ; then that a physician is to be 
summoned (sending him word, if possible, what 
poison has been taken); and that, until his arrival, 
the course indicated above should be followed. To 
save time in an emergency, the following table may 
be consulted, which gives the name of each poison 
we have already studied, and the proper treatment 
for it. 

POISON. TREATMENT. 

f Provoke repeated vomiting; 

Unknown -< Give bland liquids ; 

(Stimulate, if necessary. 



Acids — 
Sulphuric, 
Nitric, 
Muriatic, 
Oxalic, 

Alkalies — 
Hartshorn 
Soda, 
Potash, 
Lye, 



f Give an alkali ; 
I Provoke vomiting ; 
-! Give bland fluids ; 

Secure rest ; 
( Stimulate, if necessary. 

Give an acid (vinegar) ; 

Provoke vomiting ; 

Give bland liquids ; 

Secure rest ; 

Stimulate, if necessary 



94 



ACCIDENTS AND EMERGENCIES. 



POISON. 



Arsenic- 
Paris green 
Scheele" 



reen, V , 
's green, J 



Sugar of Lead, 



Corrosive Sublimate, \ 
Tartar Emetic^ J 



Phosphorus 



Lunar Caustic (nitrate") 
of silver), j 



Iodine. 



Opium — 
Morphine, 
Laudanum, 
Paregoric, etc., 

Chloral, 



Croton Oil., 



Strychnine. 



Aconite, 
Veratrum Viride 



} 



Jamestown Weed, 

Hemlock, 

Nightshade (belladonna), 

Toadstools, 

Tobacco. 

Alcohol 

Decayed Meat or Vegetables. 



TREATMENT. 

Provoke vomiting ; \ repeat 

Give dialysed iron and salt ; j several 
Give dose of castor oil ; times ; 

Secure rest ; 
b Stimulate, if necessary. 

{Give Epsom salts, \ repeat several 
Provoke vomiting, J times ; 
Give bland liquids ; 
Give dose of castor oil. 
Provoke vomiting, ") repeat 

Give strong tea, without milk, J several 
Give raw eggs and milk ; times ; 

Give dose of castor oil ; 
Stimulate, if necessary, 
f Provoke vomiting ; 

j Give five-grain doses sulphate of copper; 
' j or teaspoonful doses of turpentine. 
[Give dose of magnesia ; but no oil. 
f Give strong salt and water, ) repeat 
' \ Provoke vomiting, j many times . 

f Provoke vomiting ; 
•< Give starch and water ; 
(Give bland fluids. 

f Provoke vomiting, repeatedly; 
A Give strong coffee, without milk ; 
(Keep up the breathing. 

f Provoke vomiting; 
.-< Give bland fluids, 

( and laudanum or paregoric. 

( Provoke vomiting, once or twice ; 
.-< Give a purgative ; 

(Secure absolute quiet. 

f Provoke vomiting ; 
. < Stimulate well ; 

(Keep head low. 



Provoke vomiting ; 
Stimulate well. 



( Provoke vomiting ; 
' ( Give hartshorn and water. 

( Provoke vomiting ; 
A Give a purgative; 

(Give powdered charcoal. 



To provoke vomiting, warm water may be used 
with or without ground mustard (a tablespoonful to 



poisons. 95 

a pint of water), or ipecac (a teaspoonful of the 
powder or a tablespoonful or so of the syrup), and 
thrusting a finger down the throat. It is best to give 
large quantities (that is, a pint at a time) of warm 
water whenever vomiting is to be excited. 

Bland liquids are milk, raw eggs, some sort of 
oil, gruel, etc. 

Stimulants are tea, coffee, whisky, wine, etc., or 
hartshorn and water. Of this a teaspoonful in a 
teacupful of water will be enough for a dose. In 
making tea or coffee one must not wait to do it as if 
for. the table, but mix hot water and the leaves or 
grounds, squeeze them well, stir together, and give 
the whole — leaves, grounds, everything. At the 
same time some may be made regularly, if there are 
conveniences for it. 

Alkaline antidotes are hartshorn and water (a 
tablespoonful in two teacupfuls of water) soap and 
water, lime, whiting, soda, chalk, tooth powder, 
plaster, magnesia, whitewash, and even wood ashes. 

Acid antidotes are vinegar and lemon juice. 

In giving an antidote never wait for it to dissolve. 
Just stir it up in any fluid at hand except oil, and 
have it swallowed immediately. 

When laudanum is advised for such an irritant 
poison as croton oil, it must be given in a dose of 
half a teaspoonful to an adult, and this may be 
repeated in half an hour if the pain continues to be 
severe and there is no drowsiness. 



96 ACCIDENTS AND EMERGENCIES. 



Domestic Emergencies. 

No less important than the emergencies thus far 
considered, most of which have a sort of public 
significance, are a few more which usually occur 
within the limits of the household and try the know- 
ledge and patience of anxious parents. If these 
emergencies arose only when skilled assistance could 
be had in a moment, they might, perhaps, be omitted 
from a book like this. But they have a way of pre- 
senting themselves at the dead of night, in traveling, 
at the seashore, or in the mountains, where doctors 
are not known or are not to be had promptly, and 
those upon whom the burden of meeting them falls 
may be glad to have some simple suggestions as to 
what they may do until they can commit their in- 
terests to others better prepared to guard them. 

Cholera morbus produces vomiting and purging 
and violent cramps in the stomach. The pain may 
be so severe as to actually threaten life. There is then 
a pinched expression of the face, and a cool, clammy 
skin. In such cases, something must be done at once 
to relieve the pain. For this, laudanum may be 
given — half a teaspoonful to an adult, or ten drops 
to a child over twelve years old. At the same time 



DOMESTIC EMERGENCIES. 97 

heat must be applied to the stomach. For this pur- 
pose a mustard plaster can be used, or cloths wrung 
out of hot water and sprinkled with turpentine or 
with red pepper, or a hot-water bag, or bottle, or 
a plate heated at the fire and covered with a cloth. 
An injection containing a small teacupful of warm 
water or milk, to which a tablespoonful of tincture 
of asafcetida has been added, often gives great 
relief. 

Colic causes violent griping pain in the abdomen. 
It is usually due to something indigestible which has 
been eaten. It should be treated by hot applications 
to the abdomen, such as have just been mentioned. 
A purgative, such as castor oil or ten grains of calomel 
may be given by the mouth, and an injection of water 
and asafcetida administered, as described in speak- 
ing of cholera morbus. 

Vomiting, or nausea, due to something objec- 
tionable in the stomach, may be treated by giving 
large draughts of pretty hot water. If it be due to 
nervousness or a slight indigestion, it can usually be 
corrected by swallowing small pieces of ice, or table- 
spoonful doses of lime water, or a pinch of soda, or 
half a teaspoonful of aromatic spirits of ammonia in 
a wineglassful of water, together with the applica- 
tion to the pit of the stomach of a mustard plaster, 
or of a flannel cloth wrung out of hot water and 
sprinkled with a tablespoonful of turpentine or some 
red pepper. A lump of ice held against the pit of 



98 ACCIDENTS AND EMERGENCIES. 

the stomach often does much good. The sufferer 
should always lie down until the nausea passes off. 

Diarrhoea is usually due to a cold or to something 
indigestible which has been eaten. In either case it 
is an effort of nature to cure itself of something hurt- 
ful. So, at the start, the best thing to be done is to 
give a mild purge. It is a good plan to give a tea- 
spoonful or two of a mixture of equal parts of olive oil 
and castor oil to an infant, and a tablespoonful or two 
to an adult. Half these quantities of a mixture of glyce- 
rine and castor oil acts equally well. For infants 
nothing acts better than a tenth of a grain of calo- 
mel, given every hour or half hour till it produces a 
free movement. A small dose of equal parts of 
sweet oil and castor oil, or spiced syrup of rhubarb 
or magnesia is the best. After this, if the move- 
ments of the bowels soon return, half a teaspoon ful 
of ginger in a wineglassful of water may be given 
to an adult after every passage. If this does not 
check the diarrhoea, ten drops of laudanum may be 
given to an adult after each passage. For an adult, 
also, an injection, made of half a small teacupful of 
boiled starch, to which thirty or forty drops of 
laudanum have been added, often gives immediate 
relief. For a child over two years old half a drop 
of laudanum may be given after each passage, until 
the diarrhoea seems checked, or there is some evi- 
dence of drowsiness. A simpler remedy, which 
often acts well, is a tablespoonful of raw flour in a 



DOMESTIC EMERGENCIES. 99 

glassful of cool water, to be taken in two doses, 
half an hour apart. 

Croup. Attacks of spasmodic croup, though very- 
alarming, are rarely dangerous. There is probably 
much less real croup than is supposed, and the hoarse 
cough which children sometimes have after taking 
cold, may lead to measures which make it much worse 
for all concerned. Parents need not get excited 
when they hear what is called a "croupy" cough. 
When it occurs, they should first see what can be ac- 
complished by allaying the alarm of the child, and 
by diverting its mind. The reading of some favorite 
story or the exhihition of a favorite toy may cause 
all the symptoms of croup to disappear. 

When such mild measures are of no avail, and the 
symptoms become more urgent, the little sufferer 
should be given an emetic of a teaspoonful of syrup 
of ipecac or a heaping teaspoonful of powdered alum, 
followed by a draught of warm water. Cloths wrung 
out of water as hot as can be borne should be wrapped 
round the throat and laid upon the chest. They 
should then be covered with something to keep the 
heat in — like oiled silk or a dry cloth. 

This is all that can ordinarily be done with ad- 
vantage till a physician arrives. But it usually gives 
decided relief. In this case, and even if it does not, 
natural anxiety should not drive parents to be want- 
ing to do something else all the time. They may 
renew the hot cloths as soon as they begin to grow 



100 ACCIDENTS AND EMERGENCIES. 

cold, but beside this there is nothing to be done but 
to wait until there has been time for the spasm to 
pass off. This is hard to do, it is true ; but it is the 
best thing to be done, and far better than the fuss 
and worry, to parents and child, of trying a variety 
of methods. 

In Whooping Cough there is a strong nervous 
element, and a spasm of coughing is often brought on 
by the example of another child. So, when a child 
is seized with a fit of coughing, it ought, if possible, 
to be at once separated from other children, for its 
own good and for theirs. Then, if the fit does not 
pass away in the usual time, it may sometimes be cut 
short by pressing a lump of ice against the chest, or 
by placing hot cloths there. 

Asthmatic attacks may be treated in several 
ways. One method is founded upon the fact that 
asthma is a nervous manifestation, which grows 
worse the more the attention is directed to it. If 
the attention can be diverted the attack will often 
pass off. Occurring, as it usually does, at night, 
the darkness, the surprise, the absence of surround- 
ing activities, increase its effects. If the sufferer be 
a man, and will get out of bed, put on his gown and 
slippers, light his gas and take a book or paper and 
begin to read, he will, in many cases, soon find his 
trouble diminishing and finally disappearing. If he 
be a smoker, his cigar or pipe will help him in this 
emergency. 



DOMESTIC EMERGENCIES. 101 

A less agreeable method is to take an emetic. 
Another is to smoke the asthma cigarettes sold in 
every drug store. Another is to get some steaming 
hot water in a basin, pour into it a tablespoonful 
or more of Hoffman's anodyne, and breathe the 
ascending vapors. One of the best remedies is a 
full dose of opium in some form — for an adult, 
thirty drops of laudanum, or a tablespoonful of 
paregoric. As soon as this takes effect the spasm 
of asthma will disappear. 

Nervous attacks, which may take the form of 
shivering fits, are to be treated by putting the patient 
to bed, if possible, and giving strong hot coffee, or 
hot sweetened water, and by applying heat to the 
body by a bath or hot cloths or bottles, with a mild 
mustard plaster or turpentine placed on the pit of 
the stomach. A teaspoonful of camphor water, of 
valerian, or of Hoffman's anodyne, will often prove 
of great service. 

Toothache, depending upon a cavity in a de- 
cayed tooth, is usually very easy to stop. To do 
this a fine crochet needle should have a very small 
bit of clean cotton twisted round its point, and 
with this the hole in the tooth should be thoroughly 
swabbed out. Then the point of the crochet needle 
should be cleaned and another little ball of cotton, 
like a very small shot, should be dipped in oil of 
cloves and caught up with the end of the needle. It 
should then be laid in the hollow tooth and pushed 



102 ACCIDENTS AND EMERGENCIES. 

in, not too hard, with the end of the needle. This 
rarely fails to cure such a toothache. Sometimes 
filling the cavity with baking soda will stop the pain. 

When toothache is not due to a hollow tooth, a 
somewhat severe but usually efficient plan of treat- 
ment is to lay between the gum and the cheek a little 
wad of cotton, the size of the end of the thumb, 
soaked in spirits of camphor. This makes a sort of 
blister, but generally cures the toothache, which is 
much harder to bear. 

Earache should always suggest an examination 
of the teeth, and if one be found decayed, it must 
be extracted or at least cleaned out and packed with 
cotton and oil of cloves, as described in speaking of 
toothache. For many earaches depend upon diseased 
teeth. 

In case this is not called for, or does no good, a 
folded cloth, wrung out of hot water, with a tea- 
spoonful of laudanum poured over it, or a big, hot 
poultice — for which hops is the best material — should 
be applied to the side of the head and kept as hot as 
possible. Hot drinks should be given also, and 
enough laudanum to cause relief from pain. 

The occurrence of an earache should always lead 
to consulting a doctor, for it is often of importance 
as a sign of disease which may seriously affect the 
hearing. 

Poisoning by the common poison vine 
causes red blotches, and wheals, and blisters on the 



DOMESTIC EMERGENCIES. 103 

skin, with great burning and itching. It is best 
treated by applying cloths soaked in a solution of 
soda, a tablespoonful to a teacupful of hot water. 
Dusting with magnesia or ordinary toilet powder is 
also grateful. 

Neuralgia of the face may come on suddenly, 
when the advice of a physician cannot be obtained. 
In such a case the application of a hot cloth, wet or 
dry, may do much good, or painting the painful part 
with oil of peppermint. On the other hand, cold 
applications may do more good, although this does 
not often happen. 



104 ACCIDENTS AND EMERGENCIES. 



Signs of Death. 



In the absence of a physician it sometimes becomes 
important that others shall be able to determine 
whether death has taken place or not. The occur- 
rence of death can be recognized by the following 
signs: The breathing and pulse cease, the surface 
becomes pale, the muscles relax, the lower jaw falls 
a little, the "sight" of the eye becomes dull and 
glazed, the upper lid falls so as to partly cover the 
eyeball, then the whole body gradually cools to the 
temperature of the surrounding air and becomes 
rigid, while later decomposition sets in, and usually 
shows itself first by a greenish discoloration of the 
surface of the abdomen. 

But it does not require the detection of all these 
signs to determine that death has taken place. The 
cessation of breathing and of the heart-beat is a safe 
basis to an opinion. It requires some care, however, 
to decide that there is no breathing or circulation. 
To test the former, a cold piece of polished steel — 
like a razor blade or table-knife — can be held under 
the nose and before the mouth. If no moisture 
condenses upon it, it is safe to say there is no breath- 
ing. To test the cessation of the heart-beat, it is not 



SIGNS OF DEATH. 105 

enough to feel for the pulse at the wrist. The 
largest blood vessel in the body (see Frontispiece) 
runs directly down from the heart, along the left side 
of the spinal column, and its strong beating can be 
plainly felt in most people by pressing the finger tips 
firmly down toward the backbone, at the point below 
the breast bone called the "pit of the stomach." 
In this place the slightest pulsation of the heart can 
be felt if the walls of the abdomen permit the finger 
to get near the backbone, and here examination 
should be made before deciding that the heart has 
ceased to beat. Another test is listening over the 
region of the heart, in front of the left side of the 
chest. An acute ear can always detect the move- 
ment of the heart by sounds made by its valves, 
which, when perfect, sound like the syllables " ub- 
dup," "uf-dup," and so on. If careful listening 
fails to detect the heart sounds, and the cold metal 
fails to show any evidence of breathing, the individual 
may certainly be said to be dead. 

When, in addition to these signs, paleness, mus- 
cular relaxation, a glazing eye, increasing coldness 
and rigidity come on, it hardly requires the onset of 
decomposition — the infallible sign — to prove, beyond 
any possibility of doubt, that death has occurred. 

The electrical battery may be used in doubtful 
cases. Electricity distinguishes with absolute certainty 
between life and death. Within two or three hours 
after the stoppage of the heart the whole of the 

H 



106 ACCIDENTS AND EMERGENCIES. 

muscles of the body will have completely lost their 
electric excitability. When stimulated by electricity 
they no longer contract. If, then, when electricity 
is applied to the muscles of the face, limbs, or trunk, 
after supposed death, there be no contraction, death 
has occurred. No faint, no trance, no stupor, how- 
ever deep, can prevent the manifestation of electric 
muscular contractility. 

But ordinarily it is very easy to decide between 
death and life ; and the fear of being buried alive, 
which torments many people, is altogether without 
good foundation. The stories upon which it rests 
are such as an excited imagination might easily in- 
vent, and natural fear propagate, but they do not 
bear critical investigation. In certain European cities, 
for many years, the bodies of hundreds of thousands 
of those supposed to be dead have been placed in 
rooms where ingenious appliances and careful watch- 
ing have been used to detect the slightest evidence of 
life, and in not a single case has a mistake been found 
to have been made. 



SUPPLIES FOR EMERGENCIES. 107 



Supplies for Emergencies. 

The suggestions in the preceding pages have been, 
as far as practicable, such as could be carried out 
without having made any special provision for them. 
Nevertheless, occasionally appliances and remedies 
have been suggested, which would very much facili- 
tate the treatment, if they were accessible. These 
may be divided into medical and surgical. They 
may be arranged separately or together, but the 
former arrangement would probably best suit indi- 
vidual necessities. 

SURGICAL CASE. 

A surgical case suitable for almost any emergency 
should not contain so many things as to confuse one 
who has not a medical education. Its supplies 
should be few and simple, such as — 

i. Some absorbent cotton. 

2. A roll of old muslin or linen. 

3. Bandages, 2^ inches wide and 6 yards long, 

rolled up. 

4. Rubber adhesive plaster, on a spool, in a strip 

2 inches wide, and not less than a yard long, 
s. Scissors. 



108 ACCIDENTS AND EMERGENCIES. 

6. Pins (ordinary and safety pins). 

7. Needles, threaded with stout thread. 

8. A bottle of hartshorn, with a glass or rubber 

stopper, 

9. A bottle of laudanum, with dose marked on it. 
10. A bottle of good whisky or brandy. 

USE OF THE CONTENTS OF THE SUR- 
GICAL CASE. 

1. Absorbent cotton can be obtained at any 
drug store. It is perfectly clean and soft, and is 
prepared in such a way that it — instead of resisting 
moisture, as ordinary cotton does — will absorb it 
with great rapidity. Thus it will take up discharges 
from wounds ; and when a cool or hot application is 
desired, it can be soaked with cool or hot water. 
Sometimes it is very convenient to put it on dry 
and then squeeze the water upon some part of it 
from a sponge, when every part will rapidly become 
saturated. 

For padding splints, or making cushions to prevent 
pressure of any kind, there is nothing so good as 
absorbent cotton. 

2. Old muslin or linen can be torn into any 
shape or size that may be required, and can be used 
to spread poultices upon. It is also useful to make 
broad slings of. 

3. Bandages of the kind described are used to 
keep applications in place, to secure parts to splints, 



SUPPLIES FOR EMERGENCIES, 



109 



and to prevent injurious motion. The simplest way 
to apply them is to make circular turns around any 
part. When the latter is of even size this is a very 
easy matter. Where the part is larger at one end 
than the other, the ordinary circular turns would not 
fit smoothly. To accomplish this the rule is to begin 
at the small end and make a few turns, round and 
round, one immediately over the other, and then to 
begin to move up the limb spirally. So long as a 




Fig. 12. 

turn can be made to smoothly overlap the one before 
it about one-third, this spiral is all that is required. 
But as soon as it puckers the bandage is not carried 
on as before, but is turned down, so that the inner 
face now looks out, and the bandage, instead of 
passing up, passes downwards, so as to make a sort 
of inverted V — so, a- On now carrying the ban- 
dage on round the part, it will be found that it comes 



110 ACCIDENTS AND EMERGENCIES. 

to the front, just overlapping the preceding turn, 
and the same process can be repeated, until the 
whole bandage is neatly applied. (See Fig. 12.) 

At joints, like the ankle, knee, and elbow, the 
bandage may make a sort of figure of 8, the middle 
or crossing part being in the bend of the joint, and 
the two loops, one above and one below it. 

Bandages should never be put on so tight as to 
cause pain, and never drawn tighter above than below. 

Bandages may be fastened by pins, by stitching, by 
strips of adhesive plaster, or by splitting the end and 
carrying one tail on as before and turning the other 
back to meet it and then tying the two together. 
For narrow bandages, the latter is the simplest plan; 
for wide ones some one of the others is better. 

The width of 2)4 inches is that which is oftenest 
convenient. When a narrower bandage is called for 
— as for a finger — one of the former may be torn 
down the middle ; or, if rolled up, it can be laid on 
a firm surface and the whole roller cut in half with a 
sharp knife, just as one would cut a sausage. This 
quickly and easily makes two good finger bandages. 

4. Rubber adhesive plaster is better than any 
other kind, because it can be applied without heat or 
moisture. It sticks of itself. When applied to a 
hairy part, the hair should be shaved off, if possible. 
If not, when the plaster comes to be removed, it 
must be soaked off, or it will pull the hair out and 
cause great pain. 



SUPPLIES FOR EMERGENCIES. Ill 

Another point to be remembered is that, in chang- 
ing adhesive plaster dressings only so much should 
be removed as is necessary or as cleanliness demands. 
The rest may be left on and the new dressing applied 
up to it or over it. In the end all can be soaked off 
together. 

The plaster is most convenient to use when in 
strips, which can be cut easily and without waste if 
needed smaller, and additional strips applied side by 
side, if a greater width is wanted. 

5, 6, 7. The use of scissors, pins and needles 
need not be explained. 

The points of pins should never be left sticking 
out, and care should be used to avoid sticking either 
pins or needles through a patient's skin. 

8. Hartshorn is to be used as a stimulant to the 
heart and to the nervous system. A teaspoonful 
may be put into a tumblerful of water and a teaspoon- 
ful of the mixture given every few minutes. Its use 
by the nose everybody is familiar with. Yet it may 
be worth while to say that a full bottle of hartshorn 
should never be brought near to a patient's face. The 
stopper may be wetted and held under the nose, or a 
few drops put on a handkerchief, or the hand, and 
used in the same way. 

9. The laudanum bottle should be marked 
" Poison ! M and have the dose marked on the label. 
In surgical cases, where there is much pain, a full 



112 ACCIDENTS AND EMERGENCIES. 

dose is called for, and to give less is to trifle with 
the sufferer. 

As already remarked, laudanum is one of the very 
best local applications to wounds and bruises. It 
can be used by soaking a proper quantity of absorbent 
cotton, or a piece of old muslin, and laying it upon 
the injured part. 

10. About the whisky, it may be remarked, 
that a large dose is almost invariably useless or in- 
jurious. Even for an adult — unless a confirmed 
drinker — the proper dose is a teaspoonful in a small 
quantity of hot water — or cold water, if hot cannot 
be had — repeated every few minutes until some effect 
is produced, or a couple of ounces — about half a 
small teacupful — have been given. 

HOW TO MAKE POULTICES. 

Poultices. The commonest materials for poul- 
tices are bread, flaxseed, hops and mush. A hop 
poultice is made by pouring hot water upon hops till 
they are well moistened. A bread poultice is made 
by soaking the inside of bread in hot water or milk, 
and mashing it quite soft and even. With flaxseed 
or corn-meal the way is to put the poultice material 
on a plate, and add just enough hot water to moisten 
it. This is worked in with a large spoon or table- 
knife, just as a salad dressing is made. Then to 
this thick but damp mass, enough hot water is grad- 



SUPPLIES FOR EMERGENCIES. 113 

ually added and worked in until the whole is almost 
soft enough to run, but not quite. Poultices should 
be spread thick. To spread a poultice, a piece of 
fine old muslin (or a piece of open-meshed stuff, 
such as cheese cloth is made of, can be used), twice as 
long as the poultice is to be, is laid on a flat surface, 
and one-half of it spread smooth with the poultice 
material. The other half is to be brought over and 
pressed down on top of the poultice material, or 
another piece of muslin, or a piece of tarlatan can 
be used for this purpose, so that the poultice material 
shall not come into immediate contact with the 
skin ; then, when it comes to be removed, it will come 
off easily, all at one time, and not leave any behind 
to stick to the skin. 

A poultice must be put on hot. To secure this, 
it may be spread over a hot plate. A simpler plan, 
however, is to take the finished poultice up by its 
edges and lay it for a moment or two on something 
hot, or dip it into a vessel containing boiling water. 
Care must, however, be taken not to put on a 
poultice so hot as to burn. 

To keep a poultice warm when applied, it should 
be covered with oiled silk or several folds of 
bandage. 

It may be remarked that nothing has been said 
here about the use of " lead water and laudanum M 
or arnica, so often recommended for bruises and 
cuts. The reason for this omission lies in the fact 



114 ACCIDENTS AND EMERGENCIES. 

that neither has any merit superior to that of cold 
water or laudanum alone. When a part is hot and 
angry, there is nothing better for it than the use of 
cold water, constantly renewed until the heat and 
irritation have subsided. When pain is to be com- 
bated, laudanum alone is the best thing to use locally. 

MEDICINE CHEST. 

A small box can be bought, or made, to hold a 
few things likely to be useful in accidents or sudden 
sickness. It ought to contain — 
f Absorbent cotton. 
Sticking plaster — Rubber plaster (on a spool) is 
best, because it requires neither heat nor moisture 
for its application. 
Bandages of old muslin or flannel. 
A piece of oiled silk. 
Thread and needles. 
Pins (ordinary and safety pins). 
^ Cosmoline, Vaseline, or Cold Cream, 
i. Aromatic spirits of Ammonia. 

2. Tincture of Asafcetida. 

3. Oil of Cloves. 

4. Hoffman's Anodyne. 

5. Syrup of Ipecac. 

6. Laudanum. 

7. Magnesia. 

8. Mustard. 

9. Paregoric. 



SUPPLIES FOR EMERGENCIES. 115 

10. Spiced Syrup of Rhubarb. 

ii. Turpentine. 

To these may be added, if quite convenient : 
camphor water, essence of ginger, lime water, and 
sweet spirits of nitre. * 

Of the eleven first named, a convenient quantity 
to have would be two fluid ounces ; except of No. 3 
(oil of cloves) of which a fluid drachm would be 
plenty, and No. 7 (the magnesia) and No. 8 (the 
mustard) of both of which an ounce would suffice. 

The laudanum and paregoric ought to be in bottles 
of an altogether different shape from that of those 
containing the other remedies ; and they, and that 
of the oil of cloves, should be marked Poison / and 
have a tape or small ball and chain attached to their 
necks, so that it could be felt in the dark. Each 
bottle should have its proper dose plainly printed or 
marked on the label. 

DOSES AND USES OF THE MEDI- 
CINES. 

1. Ammonia. The aromatic spirits of ammonia 
— not hartshorn — is a valuable remedy in cases of 
sick stomach, and even vomiting. It is also useful 
in cases of nervous or sick headache, as well as in 
simple nervousness. The dose is, for an adult, twenty- 
five drops; for a child, ten drops, in about a wine- 
glassful of water. This may be given every ten 
minutes, almost indefinitely. 



116 ACCIDENTS AND EMERGENCIES. 

2. Asafcetida. The tincture of asafoetida is a 
nerve tonic, and also very soothing to the bowels. 
There is nothing better for causing the expulsion of 
wind. The dose is, for an adult, a teaspoonful ; for 
a child, twenty drops, in a tablespoonful of water. 
It can often be used as an injection when it could 
not be given by the mouth. In this case the quan- 
tity to be given is a tablespoonful for an adult and a 
teaspoonful for a child, in a small teacupful of warm 
water. 

3. Cloves. The oil of cloves is useful as a local 
application in toothache. It is also helpful in indi- 
gestion, in doses of three drops for an adult, and one 
drop for a child. It can be given rubbed up with a 
little sugar, or in a teaspoonful of sweet oil. 

4. Hoffman's Anodyne is useful in cases of 
hysterics and nervous fright or chills. The dose is, 
for an adult, a teaspoonful in a wineglassful of water. 
Children rarely require medicines of this sort. But 
when they do, as is the case with certain high-strung 
children, half the dose for an adult may be given. 

5. Ipecac. The syrup of ipecac is a fairly good 
emetic. But it must be used freely. An adult should 
be given a good tablespoonful, and an infant as near 
a teaspoonful as possible. It will do no harm, and 
when an emetic is called for, it is no time to run any 
risk that the dose given may not be large enough. 
It is often usefully employed in cases of poisoning, 
convulsions, croup, whooping cough or asthma. 



SUPPLIES FOR EMERGENCIES. 117 

6. Laudanum. Laudanum is the tincture of 
opium, and has all its properties. It is one of the 
most useful drugs in the world, and yet it is a danger- 
ous one. There need, however, be no fear of poi- 
soning with any preparation of opium if ordinary 
doses are given, and if these doses are not given closer 
together than half an hour, and if they are stopped as 
soon as pain is decidedly lessened or drowsiness 
comes on. Occasionally, small doses of opium cause 
great alarm, but there is much less fear about opium 
poisoning among doctors now than there used to be. 
It may be considered safe to give twenty-five drops of 
laudanum to any adult, when there is severe pain, 
and to repeat this dose every half hour until the pain 
is lessened or drowsiness begins to appear. One of 
the signs of the effect of opium on the system is a 
contraction of the pupil of the eye, which does not 
expand in the dark. This ought always to lead to a 
discontinuance of any preparation of opium which 
has been used. 

To check diarrhoea, sometimes, a drop of laudanum 
every hour will prove successful very soon. Yet, 
ten or fifteen drops may be given to an adult after 
each movement, if the smaller quantity does not 
suffice. 

For cuts and bruises there is no better application 
than pure laudanum. A soft cloth soaked in lauda- 
num can be bound on, and occasionally wetted with 
it, without removal. It quiets pain and promotes 



118 ACCIDENTS AND EMERGENCIES. 

healing. The same application is often very sooth- 
ing in face-ache, toothache and earache, as well as 
in the pains of rheumatism and neuralgia. (See 
" Paregoric") 

7. Magnesia. Magnesia is a mild remedy to 
open the bowels, usually employed for children. 
The dose being a teaspoonful, given in water or 
milk. It may also be used for sour stomach, when a 
pinch will generally be enough. 

8. Mustard. In the use of ground mustard for 
plasters, it should always be mixed with an equal 
part of flour. Even then it acts quickly and must 
be removed in a few minutes, as soon as the skin is 
well reddened. Where it is desired to leave a mus- 
tard plaster on for more than a few minutes, it 
should be made of one part mustard to three or more 
of flour. Every mustard plaster should be removed 
as soon as the skin becomes red, and not allowed to 
make a blister, because such blisters are excessively 
painful and very hard to heal. 

As an emetic, mustard is used by stirring a tea- 
spoonful of the ground seeds in a teacupful of luke- 
warm water. 

9. Paregoric. Paregoric is an opium preparation 
which contains, besides opium and other things, some 
camphor. It is the best preparation for children, 
because the dose is easier to measure than that of 
laudanum. An infant a few hours old will stand 
three drops, and in a few days, five. In a month, ten 



SUPPLIES FOR EMERGENCIES. 119 

are not too many, and twenty may be given any time 
after six months. An adult can take a tablespoonful. 
It may be used internally in all the cases where lauda- 
num has been recommended. (See " Laudanum.") 

10. Rhubarb. The spiced syrup of rhubarb is an 
excellent mild laxative for the bowels. A teaspoon- 
ful is the dose for an infant or small child. It is 
useful at the beginning of a diarrhoea in children, 
as it empties the bowels of what irritates them, 
and also has a soothing and healing influence. 

ii. Turpentine. Spirits, or oil, of turpentine can 
be used wherever mustard has been recommended as 
an external application. For this purpose a soft 
flannel or muslin cloth should be dipped in turpen- 
tine, wrung out nearly dry, laid on the surface and 
covered with oiled silk or a few thicknesses of dry 
cloth, to prevent evaporation. - 

Red pepper may sometimes be used instead of 
mustard, though it is more energetic in its action. 
When moistened and applied to the skin, red pepper 
first causes a feeling of warmth, and later of intense, 
fiery burning. If left on long enough it will cause a 
blister. But this ought never to be done. Red pep- 
per may be used in cases of colic or cholera morbus, 
where it quiets pain by its counter-irritant effect, and 
stimulates the nervous and circulatory systems. In 
nausea it sometimes does good by the latter process. 



INDEX 



PAGE 

Abdomen, wounds of. 55 

Accidents, railroad and machinery 63 

Acids, as antidotes 95 

burns with 38 

poisoning by 86 

Aconite, poisoning by 92 

Alcohol, poisoning by 92 

as a stimulant 67 

Alkalies, as antidotes , 95 

as poisons 88 

burns with 38 

Ammonia, as an antidote 95 

as a medicine 115 

as a poison 88 

as a stimulant 111 

Antidotes, to prepare 95 

(See various poisons.) 

Apoplexy 32 

Arsenic, poisoning by 88 

Arteries, wounds of. 73 

in arm 74, 76 

in foot 77 

in forearm 75 

in hand 75 

in leg 77 

in scalp 78 

in thigh 77 

Asafoetida 116 

Asthmatic attacks 100 

Back, broken 52 

Bandaging 108 

Bites, of cats 60 

of dogs 60 

of rats 60 

of serpents 59 

Black-drop, poisoning by 90 

Bland fluids 95 

Bleeding. (See Hemorrhage.) .... 

Blood vessels, location of. 69 

Bones, broken. (See Fracture.) 

Brain, disorder of. 25 

injuries of 35 

Bruises 54 

Bugs, in ear 23 

Burns 36 



Capillaries 71 

121 



PAGE 

Carbolic acid, poisoning by 87 

Carron oil 37 

Catalepsy, 34 

Cat bite , 60 

Caustic, burns with 3! 

poisoning by 89 

Chloral 91 

Choking 17 

Cholera morbus 96 

Circulation, description of. 69 

disturbance of. 25 

Cleansing wounds 56 

Cold and heat, effects o£ 41 

Colic 97 

Collapse. (See Shock.) 

Collar bone, fracture of. 51 

Contusions 54 

Convulsions 32 

Corrosive sublimate, poisoning by. 89 

Cramps 96,97 

Croup 99 

Crush 6$ 

Cuts. (See Wounds, incised.) 

Cut throat 56 

Death, signs of. 104 

Decayed meats or vegetables 93 

Depression. (See Shock.) 

Diarrhoea 98 

Dislocations..- 45 

Dog bites 60 

Drowning 12 

Drunkenness. (See Intoxication.) 

Ear, foreign bodies in 93 

Earache io« 

Emergencies, domestic 96 

Emetics 94 

Epilepsy 30 

Eye, black 54 

lime in 2s 

splinters in 5* 

Fainting 29 

Fishhooks 57 

Fits 24, 30 32 

Fluids, bland 95 

Foreign bodies, in ear 23 



122 



INDEX. 



PAGE 

Foreign bodies, in eye 20 

in mouth 18 

in nose 22 

in throat 17 

in windpipe 17 

Fractures 48 

compound 52 

Freezing 41 

Gases, noxious 16 

Glass, splinters of. 58 

Gunshot wounds 61 

Hanging 16 

Hartshorn. (See Ammonia.) 

Heat, effects of. 36 

exhaustion 39 

stroke 38 

Hemlock, poisoning by 92 

Hemorrhage 69 

capillary 72 

from arteries 73 

from veins 73 

from bowels 81 

from lungs 80 

from nose 80 

from stomach 80 

internal 81 

Hooks, fish 57 

Hydrophobia 61 

Hysterics 30 

Insects, in ear 23 

stings of. 59 

Insensibility 24 

Intoxication.. 26, 33 

Iodine, poisoning by 90 

Jamestown weed, poisoning by 92 

Jaw, dislocation of. 45 

fracture of. 52 

Joints, injuries of. 45 

Laudanum 117 

poisoning by 90 

Lead, sugar of, poisoning by 89 

Lightning stroke 40 

Lime, in eye, 22 

Liniments containing poison 88 

Liquids, bland 95 

Litters for injured persons 82 

Lungs, hemorrhage from 80 

Lye, burns with 38 

poisoning by 88 



PAGE 

Machinery accidents 63 

Meats, decayed, poisoning by 93 

Medicine chest 114 

use of. 115 

Monkshood, poisoning by 92 

Morphine, poisoning by 90 

Muriatic acid 86 

Mustard 118 

Nausea 97 

Needles, wounds with 57 

Nervous attacks 101 

Nightshade, poisoning by 92 

Nitric acid 86 

poisoning by 86 

Nose, bleeding from 80 

foreign bodies in..i 22 

Oil of vitriol. (See Sulphuric Acid.) 

Opium, poisoning by 90 

Oxalic acid, poisoning by 87 

Paregoric, as a medicine 118 

poisoning by 90 

Paris green 89 

Phosphorus 89 

Pin wounds 57 

Poisons 85 

table for treatment 93 

Poison vine 102 

Potash, poisoning by 88 

Poultices 112 

Railroad accident injuries 63 

Rat bites 60 

Respiration, artificial 12 

obstructions to 12 

Resuscitation, from drowning 12 

from opium stupor... 91 

Scalds 36 

Shock 66 

Silver, nitrate of. (See Caustic,lunar.) 

Skull, fracture of 52 

Snake bites 59 

Soda, poisoning by 88 

Spanish-windlass 76 

Spinal column, fracture of. 52 

Spitting blood. (See Hemorrhage 
from Lungs.) 

Splinters 58 

Splints 53 

Sprains 43 

Stimulants 15, 86, 95, in, 112 



INDEX. 



123 



PAGE 

Stimulation 15, 67 

Stings of centipedes 59 

scorpions 59 

serpents 59 

tarantulas 59 

insects 59 

Stomach, hemorrhage from 80 

Strangling. (Strangulation) 16 

Stunning 35 

Strychnine, poisoning by 92 

Sublimate, corrosive, poisoning by. 89 

Suffocation 16 

Sugar of lead, poisoning by 89 

Sulphuric acid, poisoning by 86 

Sunburn 38 

Sunstroke 38 

Supplies for emergencies 107 

Surgical case 107 

use of. 108 

Tartar emetic, poisoning by 89 

Thorns 58 

Toadstools, poisoning by 93 

Tobacco, poisoning by 92 



PAGE 

Toothache 101 

Transportation of the injured 82 

Unconsciousness 24 

doubtful cases 26 

treatment of 29 

Vegetables, decayed, poisoning by 93 

Veins, wounds of. 73 

Vitriol, oil of. 86 

Vomiting, to allay 86, 97 

to produce 94 

Washing wounds 56 

Whooping cough 100 

Windlass, Spanish 76 

Wounds 54 

cleansing of. 56 

contused 55 

gunshot 61 

incised 55 

lacerated 56 

poisoned 59 

punctured... 57 



THE 

AMERICAN HEALTH PRIMERS. 

EDITED BY W. W. KEEN, M. D., 
Fellow of the College of Physicians of Philadelphia, 

12 Volumes. 32mo. Cloth Binding, 50c. May be Ordered through any 

Bookseller. 



This Series of Health Primers is prepared to diffuse as widely and 
cheaply as possible, among all classes, a knowledge of the elementary facts 
of Preventive Medicine. They are intended incidentally to assist in curing 
diseases, and to teach people how to form correct habits of living and take 
care of themselves, their children, employees, etc. 

They are written in a plain, untechnical style, by well-known professional 
gentlemen, with especial reference to our Climate, Sanitary Legislation 
and Modes of Life. 

I. HEARING AND HOW TO KEEP IT. With Illustrations. By 
Chas. H. Burnett, m.d., of Philadelphia, Aurist to the Presbyterian 
Hospital. With Illustrations. 

Contents. — The Structure of the Ear ; The Physics and Physiology of 
Sound and Hearing ; Diseases and Injuries of the Ear, including Deaf- 
Dumbness and the avoidance of improper treatment ; The Care of the Ear 
in Health and Disease; The Relief of Deafness, and the Education of Deaf 
Children. 

II. LONG LIFE AND HOW TO REACH IT. By J. G. Rich- 
ardson, m.d., of Philadelphia, Professor of Hygiene in the University 
of Pennsylvania. 

Contents. — Introductory Considerations, Causes of Disease and How to 
Avoid Them ; Heat and Cold as Causes of Disease ; Contagious Diseases 
and How to Escape Them ; Rules regarding Proper Clothing ; Pure Air ; 
Ventilation; etc., and the Fatal Effects of Impure Air; Pure Water and 
the means of obtaining it ; and where not to get it ; Baths, their Value and 
Evils; Houses, Drains, etc.; Food and Digestion ; Modes of Cooking, etc.; 
Impure and Adulterated Food and Drink, and the means to Detect Them ; 
Exercise, and How and When to take it ; Sleep, Deficiency of. Means of 
Promoting, etc.; The Mind ; Brain Diseases ; Intellectual Labor, etc ; The 
Trichinae or Pork Worm ; Insects, Ringworm, etc.; Old Age, and the best 
way to meet it. 

III. THE SUMMER AND ITS DISEASES. By James C.Wilson, 
m.d., of Philadelphia, Lecturer on Physical Diagnosis in Jefferson 
Medical College. 

Contents. — The Summer; Sunstroke and Heat Fever; Summer Diar- 
rhoea and Dysentery ; Cholera-Infantum and Children's Diseases ; Summer 
and Autumnal Fevers ; Summer Colds and Hay Asthma ; The Skin in 
Summer and its Diseases, etc. 



THE AMERCAN HEALTH PRIMERS— (Continued). 

IV. EYESIGHT AND HOW TO CARE FOR IT. With Illustra- 
tions. By George C. Harlan, m.d., of Philadelphia, Surgeon to the 
Wills (Eye) Hospital. 

Contents. — Introduction ; The Anatomy and Physiology of the Eye ; 
The Ophthalmoscope ; Injuries and Diseases of the Eye ; Optical Defects ; 
Spectacles ; Practical Hints for the Care of the Eyes ; Effects of School 
Life upon the Eyesight, etc. 

V. THE THROAT AND THE VOICE. With Illustrations. By J. 
Solis Cohen, m.d., of Philadelphia, Lecturer on Diseases of the 
Throat in Jefferson Medical College, and on the Voice in the National 
School of Oratory. 

Contents. — Part I. — Construction of the Throat ; Sore Throats; Diph- 
theria ; Croup ; Enlarged Tonsils ; Laryngitis ; Foreign Bodies and Morbid 
Growths; Paralysis; Spasm; Neuralgia of the Throat ; Catarrhs, etc. Part 
II. — The Voice; Acoustics; The Vocal Organ; Vocal Culture; Improper 
Use of the Voice ; Vocal Gymnastics ; Defects of and Care of the Voice. 

VI. THE WINTER AND ITS DANGERS. By Hamilton Osgood, 
m.d., of Boston, Editorial Staff, Boston Medical and Surgical Journal. 

Contents. — General Considerations; Dangers from Errors in Dress; 
Carelessness and Ignorance in Bathing ; Inattention to Pulmonary Food ; 
Danger from Overheated Air and Poor Ventilation ; Indifference to Sun- 
shine ; Sedentary Life and Neglect of Exercise ; Dangers of School Life ; 
Winter Amusements; Closing Suggestions, etc. 

VII. THE MOUTH AND THE TEETH. With Illustrations. By 
J. W. White, m.d., d.d.s., of Philadelphia, Editor of the Dental 
Cosmos. 

Contents. — The Mouth; Anatomy and Development of the Teeth; 
Temporary Teeth ; Difficult Dentition ; Permanent Teeth ; Nutrition of the 
Teeth ; Food in its Relations to the Teeth ; Nervous Relations ; Constitu- 
tional Peculiarities ; Varieties, Defects and Irregularities of the Teeth ; 
Tartar ; Salivary Calculus ; Decay ; Caries ; Toothache ; Extraction ; 
Hemorrhage ; Hygiene of the Mouth ; Reparative Treatment ; Substitu- 
tion ; Artificial Teeth, etc. 

VIII. BRAINWORK AND OVERWORK. By H. C. Wood, Jr., 
m.d., of Philadelphia, Clinical Professor of Nervous Diseases in the 
University of Pennsylvania. Member of the National Academy of 
Science. 

Contents. — Nervous Diseases Increasing; General Causes of Nervous 
Trouble; Excesses; Exposure, etc.; Effects of Emotional and Intellectual 
Work; Unnecessary Work ; Women's Work, etc.; Rest and Recreation; 
Exercise ; Vacations ; Camping Out ; Sleep ; Stimulants During Labor ; 
Signs of Nervous Breakdown. 

IX. OUR HOMES. With Illustrations. By Henry Hartshorns, 
m.d., of Philadelphia, formerly Professor of Hygiene in the University 
of Pennsylvania. 

Contents. — Introduction ; Situation ; Construction ; Light ; Warmth ; 
Ventilation ; Water Supply ; Drainage ; Disinfection ; Population ; Work- 
ingmen's Homes. 



THE AMERICAN HEALTH PRIMERS— (Continued). 

X. THE SKIN IN HEALTH AND DISEASE. With Illustra- 
tions. By L. D. Bulkley, m.d., of New York, Physician to the Skin 
Department of the Demilt Dispensary and of the New York Hospital. 

Contents. — Anatomy and Physiology of the Skin ; The Care of the 
Skin in Health ; Diseases of the Skin; Parasites, etc.; Diet and Hygiene 
in Diseases of the Skin. 

XI. SEA AIR AND SEA BATHING. With Illustrations. By 
John H. Packard, m.d., of Philadelphia, Surgeon to the Episcopal 
Hospital. 

Contents. — Introduction; Different Seaside Resorts ; Mud, Sand, Turk- 
ish and other Baths; Sea Bathing; How to Float and Swim; Accidents; 
How to Treat the Apparently Drowned ; Effects of Sea Bathing for In- 
valids ; Cottage Life and Amusements at the Seashore ; Sanitary Matters ; 
The Seashore as a Winter Resort; Excursions to the Seashore. 

XII. SCHOOL AND INDUSTRIAL HYGIENE. By D. F. Lin- 
coln, m.d., of Boston, Mass., Chairman Department of Health, Ameri- 
can Social Science Association. 

Contents. — Part I. — School Hygiene ; General Remarks ; Mental and 
Emotional Strain of Scholars ; Amount of Study ; Growth and Exercise ; 
Care of the Eyes ; School Desks and Seats ; A Model School Room ; 
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Colleges ; Contagious Diseases. Part II. — Industrial HygieDe ; Injurious 
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SLIGHT AILMENTS; THEIR NATURE AND TREATMENT. 

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ON VACCINATION AND SMALLPOX. Showing the reasons why 
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